In today’s challenging healthcare environment, insurance is aggressively working to limit provider reimbursements. To maximize your practice’s out-of-network revenue you’ll need a partner who understands the process of out of network billing and has the experience to overcome all the obstacles the insurance will put in the way of your reimbursement. We will customize a solution and process for your practice.
An often-overlooked part of out-of-network billing is the administrative process that takes place before a patient is even seen. How your office communicates with patients and the information gathered at the start of the relationship plays a significant role in making the out of network billing process easier.
Ensure all the necessary information is being gathered at the first point of contact. Out of network billing company or out-of-network expert requires a more robust amount of information to be collected about a patient’s history and benefit information.
Ensure the right messaging is going out to patients about their responsibilities and expectations. An informed and engaged patient can become a powerful ally against the insurance companies when negotiations and appeals begin.
Ensure you’re complying with all state and federal laws. We’ll review your current policies and help you produce new ones to make sure your practice is protected from any future audits or litigation.
Sometimes, money is lost before the claims billing is submitted. If you’re unaware of how different procedure codes will process when they’re submitted together or unaware of the diagnoses deemed medically necessary for a procedure you’re performing, you could significantly delay payment or lose out entirely on additional money.
Our out of network billing expert will review your progress notes, operative reports and code selections to make sure you’re coding to maximize your revenue on the claims of cardiology medical billing and chiropractic medical billing. We’ll also keep you informed on how different coding strategies payout from different payers so you’re always up-to-date on the best way to code your claims.
Insurance companies cannot legally underpay you or withhold your money from you, so their most used tactic is to delay and put up obstacles to payment. They’re hoping you’ll eventually give in and leave money on the table. That’s why you need aggressive follow-up.
Our team will go after every claim systematically to make sure nothing falls through the cracks and to avoid delays in processing. We’ve seen every game the insurance plays and have developed processes and tools to work around them. We’ll do everything we can to keep the insurance on its toes and reduce the payment cycle time.
One of the keys to out of network billing success is successful negotiations with insurance. Many insurance will attempt to negotiate a case agreement on a claim-by-claim basis.
Success in this part of the out of network billing process depends on three things:
We will research each negotiation thoroughly, negotiate on your behalf, track our success and keep you informed along the way.
In the out of network billing process, you need to appeal more than just denials. Our team systematically appeals delays in insurance response times, claim denials, procedure denials and underpayments or low payouts on claims. While the process can be tedious, it’s an essential tool for making sure you get paid fairly and helps set a precedent for the insurance company when dealing with your office.
Sometimes, the normal appeals process is not enough, and legal action may be required to get you fair compensation. In those cases, we partner with law firms specialized in OON arbitrations and litigations to take the appropriate legal action to ensure fair payment.
We aggressively appeal to time delays, inappropriate denials and underpayments or low payouts.
One of the ways insurance seeks to discourage providers from staying out of the network billing is by sending checks to patients. This presents a unique challenge in the out of network billing process. Without an effective strategy and system to communicate with patients and track outstanding checks, your practice will lose out on a large portion of your pay.
An effective end-to-end strategy to deal with patient bills is the only way to minimize lost opportunity and lost revenue. Too aggressive an approach and you could lose patients before the service is performed or lose out on repeat business. Too late a process and you could leave thousands of dollars uncollected per case.
Our out-of-network expert will work with your practice to ensure every patient check is tracked well and every patient portion is collected fully.
Medical billing in general, can seem like a mystery box; claims go in and you’re never sure what will come out.
With an out of network billing company, the mystery only increases since there is no contract to clearly lay out what you should expect back in payment. That’s why we believe firmly in total transparency and data.
You will always have access to our entire workflow, so you can see what we’re doing and when we’re doing it. You can rest assured that your claims are getting all the focus they need and learn what to expect as your experience with us grows.
We’ll also meet with you regularly to go over our standard KPI reports and work with you to customize the reports you need to make best decisions for your practice. With data, we can help take the guesswork out of network billing process.