Out of Network Billing

Administrative

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 OON billing process easier.

We will work with you and your team to:

Data Gathering
Ensure all the necessary information is being gathered at the first point of contact. Out-of-network billing requires a more robust amount of information be collected about a patient’s history and benefit information.

Patient Communication
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.

Add Compliance
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.

Coding

Sometimes, money is lost before the claim 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.

We’ll review your progress notes, operative reports, and code selections to make sure you’re coding to maximize your revenue on the claim. We’ll also keep you informed on how different coding strategies pay out from different payers so you’re always up-to-date on the best way to code your claims.

Aggressive Follow Up

Insurance companies cannot legally underpay your 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 insurances play and have developed processes and tools to work around them. We’ll do everything we can to keep the insurances on their toes and reduce the payment cycle time.

Negotiations

One of the keys to out-of-network billing success is successful negotiations with insurances. Many insurances 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:

1) Having all the necessary information on the patient, benefits, insurance, and plan prior to entering the negotiation,
2) Incessantly, and intelligently pushing for the highest pay out possible and,
3) Systematically tracking your negotiation history to find patterns and ensure you’re using the right approach with each plan.
We will research each negotiation thoroughly, negotiate on your behalf, track our success, and keep you informed along the way.

Appeals

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 sets 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 time delays, inappropriate denials, and underpayments or low payouts.

Patient Billing

One of the ways insurances seek to discourage providers from staying out of network is 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 lax a process and you could leave thousands of dollars uncollected per case. We’ll work with your practice to ensure every patient check is tracked and every patient portion is collected.

Tansparency & Reporting

Medical billing, in general, can seem like a mystery box; claims go in and you’re never sure what will come out. With out-of-network billing, 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 the best decisions for your practice. With data, we can help take the guesswork out of the out-of-network billing process.