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COURSE 5

Mastering Out-of-Network Billing & the NSA

Surgical subspecialists, proceduralists, practice managers, and RCM directors

A complete guide to building and operating a sustainable out-of-network surgical practice — covering NSA compliance, QPA strategy, IDR mechanics, and AI-powered dispute management with Sydra.

10 lessons

lifetime access
certificate of completion

Course curriculum

1The OON Decision: Is It Right for Your Practice?Free preview20–25 min

Learning objectives

Model the revenue impact of going OON for your specific specialty and volume
Understand which practice types and specialties benefit most from OON status
Evaluate hybrid OON/in-network models as a transition strategy

Key takeaway: For proceduralists, the OON math usually works. The question is not whether to do it, but how to structure it to minimize patient friction.

2The Legal & Regulatory Landscape25–30 min

Learning objectives

Understand the No Surprises Act requirements that apply to your practice




Identify the distinction between facility-based and office-based care under NSA rules
Implement a compliant patient notification workflow

Key takeaway: NSA compliance is not optional. But a well-designed compliance workflow is also a patient communication tool that builds trust.

3Understanding the QPA: Your Adversary and Your Anchor25–30 min

Learning objectives

Explain how payers calculate the Qualifying Payment Amount
Identify methodological flaws in QPA that systematically undervalue complex care
Document above-QPA value from the first clinical encounter

Key takeaway: QPA is a floor, not a ceiling. Your job is to systematically document why your services warrant payment above it.

4Patient Communication & Consent20–25 min

Learning objectives

Develop scripts for front-desk conversations about OON status
Design a consent and GFE workflow that complies with NSA requirements
Use financial transparency as a patient retention and trust-building strategy

Key takea

📌 Mastering Out-of-Network Billing (Chennai)
🏢 The MD Academy
📍 Chennai