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3 things you need to know about out-of-network billing

October 1, 2019

Out-of-network (OON) billing can be a strong source of income for your practice, particularly important in today’s ever-evolving and challenging insurance climate. This means it’s vital to know the ins and outs of the out-of-network billing process so you can avoid interrupted revenue flow and sidestep reimbursement hurdles from insurance companies.

The experts at Coronis know the challenges of OON billing, which is why we’re sharing 3 things you need to know about out-of-network billing.

1.) The Out of Network Billing Process

Before you even see OON patients, your office must be prepared by communicating with them and gathering their information. Because OON billing needs to be more thorough, it’s imperative to keep up with patients throughout the process, as insurance companies often send checks to patients directly to dissuade you from going out of network.

Yet, it can be a challenge to balance this process: be too assertive and risk losing the patient beforehand or not getting repeat business; be too accommodating and risk leaving money on the table with each case.

How Coronis Can Help?

We make sure all necessary information is collected at initial contact, particularly regarding patient history and benefits.

– Our staff will review your current practices and policies to make sure you’re abiding by all state and federal laws to protect you from future audits and/or litigation.

– Our trained personnel will track each patient check so that the appropriate patient portion is collected.

– We create the proper messaging so patients understand their responsibilities and expectations, which is helpful later when negotiations and/or appeals with insurance companies materialize.

2.) Before and After the Claims

OON claims continue to be on the rise, even for patients with health insurance. Revenue can be lost before an OON claim is submitted due to being unaware of the different procedure codes or the medically necessary diagnosis for a procedure you’re performing. Since insurance companies are prohibited from underpaying you or withholding due reimbursements, they delay payment with various obstacles so that you relent and leave money on the table.

How Coronis Can Help

We help you review notes, reports, and code selections. We also help you be up-to-date on changing codes and coding strategies from the various payers so you know the best methods for coding claims. We also assist you in being aggressive about your follow-ups and in systematically going after each claim. Our experience helps to avoid delays in processing so you’re not waiting to get paid.

3.) Negotiating and Appealing

In negotiating with insurance companies, you have to be on your game to have consistent OON billing success. Moreover, OON billing regularly requires that you appeal not just denials, as insurance companies will attempt to delay everything from response times to claim or procedure denials.

How Coronis Can Help?

  1. Making sure you have all necessary patient information (benefits, insurance, etc.) before negotiations begin.
  2. Rigorously and strategically pushing for the highest reimbursement possible.
  3. Ensuring that the optimal approach is always being implemented.
  4. Systematically appealing all delays.
  5. When the appeals process is not sufficient, enlisting with trusted law firms that specialize in out-of-network cases to arbitrate and litigate appropriately so you get fairly reimbursed.

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