Out of Network Billing has always been complex and challenging for all the parties involved: patient, provider and the billing team. While it goes as a surprise bill to the patient most of the time affecting them financially and mentally. For Providers, it can mean additional expense follow-up with patients and insurance for getting the payments for the services done.
What does Out of Network Service mean in Medical Billing?
An “Out Of Network (OON) Provider” means the provider is not in contract with your insurance company. Most insurance plans cover only if providers are on contract or In-Network with them for a negotiated rate of reimbursement, else it becomes Out of Pocket expense for the patient.
Certain health plans cover the OON services, however, the coverage percentage will be comparatively less making the Patients out of pocket expense higher.
Challenges Involved in Out of Network Billing
- Payers are on a continuous effort to keep themselves away from OON reimbursement, which means the provider can be at risk if he services OON patients. However, there is a lot of benefits and profits as well if things are planned rightly and executed.
- Most often payments for OON services are directly sent to the patient to keep the providers away from continued OON services and also to protect the patient from any surprise bills.
- Follow-up with Patients for the payment can be time taking and cost involved.
- Billing team needs to put on extra effort to process the claims and ensure the provider gets his due reimbursement.
Myths about Out of Network Billing in Ambulatory Surgery Centers (ASC)
In recent times, there has been an increase in such myths about Out of Network Billing for Ambulatory Surgery Centers.
- Only In-Network Services Get Maximized Revenue
This is a very common myth among the providers that servicing Out of network can mean revenue loss and only In-Network provide to get his maximum reimbursement. While the OON billing can be challenging and risky, they worth taking the risk most of the time OON billing if handled appropriately can result in an immense gain. - OON Billing is not Practical in the Current Era
Most physicians and patients try to stay away from OON billing possibly, fearing the financial loss, the stress involved in getting them paid, strategies involved to process them. However, it is advised to get into it as the opportunities for improved payment percentage and growing your profit. - Handling OON billing in-house is a Better Option
OON billing requires specialized billing and coding team with expertise on handling Out of network claims efficiently. An Outsourced Medical Billing Company can handle with their experience to ensure maximum reimbursement.
To more about Out of Network Billing Challenges and partner with a Medical Billing Company reach out to ecare
About ecare
ecare is one of the top Medical Billing Companies in India with happy and satisfied clientele who have been with us for more than 2 decades. We are experts in handling Out of Network Billing for all specialties and can guarantee maximum reimbursement within a limited time period. To know more about the benefits of outsourcing your RCM process or OON Billing to Ecare contact us today at 813-666-0028 or visit our website www.ecareindia.com.