The Healthcare Financial Management Association (HFMA) marked its 80th anniversary at its Annual Conference in National Harbor, MD, and the framing of the conference said a lot on its own. The headline conversation was about moving from cost containment to financial vitality. 

For the better part of a decade, healthcare finance leaders have focused on optimizing the business they already have. That includes nuts-and-bolts tactics like cost reduction, revenue cycle optimization, and, more recently, applying AI to drive incremental efficiency. Those efforts are far from finished, but they’re producing diminishing returns. The next phase of margin improvement won’t come from squeezing more out of existing operations. It will come from tapping new sources of reimbursement. 

That’s why I spent four days having some version of the same conversation about Independent Dispute Resolution (IDR), the underutilized but highly impactful arbitration process created by the No Surprises Act.

‍

IDR no longer carries an asterisk

Since the No Surprises Act took effect, the loudest voices in the room belonged to payors and to skeptics who doubted IDR would survive. The early narrative was about dispute backlogs, litigation, and dysfunction. That’s changing. 

HHS, DOL, and the Treasury recently signaled that the process is here to stay in the IDR Operations Final Rule, and the tone of HFMA Annual reflected an industry that is waking up to that reality. IDR now has a sense of permanency, and finance leaders are starting to see it for what it is: a tool sitting on providers’ side of the table to get reimbursed fairly for out-of-network care.

The most surprising takeaway from the conference was the perception gap. I spoke with leaders from large, sophisticated health systems who assumed their peers were already running IDR programs at scale. They are not. A handful are dabbling. A few have handed it off to an incumbent revenue cycle vendor or outside counsel and moved on. The overwhelming majority have not started, and many of them said the same thing in almost the same words: we know the opportunity is there, we just did not know where to begin.

That is an honest answer, and a fair one. IDR is a genuinely complex process. It is barely four years old. The rules keep evolving, many states layer their own arbitration processes on top of the federal one for some commercial payors, and the economics vary meaningfully by geography and payor mix. There are very few people in the country with real operating experience here. These reasons, combined with a run of negative press that has spooked some legal and comms teams, have kept a lot of IDR programs on the shelf.

‍

The CFO is the one to pull it all together

One structural shift came up in nearly every conversation with executives championing IDR: the process is bringing payor contracting and revenue cycle together. The two functions have always worked side by side, but rarely in lockstep. Contracting negotiated the deal, revenue cycle executed it, and each ran on its own track. That doesn't work here, and CFOs know it. Increasingly, they are the ones holding both threads.

The reason is strategic. Out-of-network exposure used to be almost purely a liability in a payor negotiation. A credible IDR capability shifts that. When a CFO knows there is a “safety net” in place if a contract negotiation forces the organization out of the network, the negotiation itself changes. For the sake of patient access, no organization wants to step away from a payor. But the leaders thinking most clearly about this recognize that the ability to do so, without hemorrhaging revenue, is defensive leverage. 

Some worry that building an IDR capability signals a willingness to walk, and that it sours the very payor relationships contracting is trying to protect. I'd argue the opposite. Every negotiation is shaped by what happens if the two sides can't reach a deal. When out-of-network means a revenue cliff, the payor has the upper hand. When it means a disciplined arbitration process with a proven track record for delivering fair reimbursement, the conversation changes before anyone sits down. My bet is that health systems that can effectively operate out of network will likely be the ones that don’t have to.

‍

Compliance is the IDR differentiator

One idea I found myself repeating throughout the week was this: providers should take advantage of the fact that the IDR process exists. They should not take advantage of the process.

Some of the criticism surrounding IDR stems from practices that were never sustainable to begin with, such as requests for absurd multiples of Medicare and claims pushed through arbitration that never belonged there. That behavior fuels payor resistance, undermines confidence in the process, and hands ammunition to the very people who want the process rolled back. It also, eventually, catches up with the organizations doing it.

Health systems interested in building sustainable IDR programs must operate differently. That means screening claims rigorously so only legitimate disputes enter arbitration, then submitting offers grounded in defensible benchmarks and other objective data. The mistake, though, is assuming compliance and scale are mutually exclusive. Technology eliminates this tradeoff, making it possible to pursue every legitimate dispute—not just the highest-dollar ones—with the same level of rigor and consistency.

‍Purpose-built IDR software allows health systems to evaluate every potentially eligible claim, apply objective eligibility criteria, batch claims effectively, develop credible offer strategies, and manage disputes efficiently across both federal and state processes. Instead of forcing organizations to choose between disciplined execution and broad participation, it enables both.

‍

Where IDR goes from here

Early-adopting physician groups have already established the playbook. Their experience has demonstrated not just that IDR works, but what it takes to make it work consistently. Health systems are now applying those lessons across hospital-based and out-of-network service lines, and many of the finance leaders I met at HFMA are beginning to model what that opportunity could mean at enterprise scale.

My advice to those leaders: treat IDR as a strategic reimbursement capability, not a project off the side of the billing team’s desk. Get contracting and revenue cycle in the same room. And hold whoever runs your program, internal or external, to a compliance standard you would be comfortable defending in front of a regulator, a payor, and a reporter on the same day.

The process exists, and still exists, for a reason. The health systems that engage with it seriously, responsibly, and at scale will recover revenue they're entitled to, and, in doing so, create financial capacity to fund the care many organizations are struggling to sustain today. 

That was true before the Annual Conference. After a week of conversations there, I am convinced the market is finally catching up to it.