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Medicare Compliance & Reimbursement

Billing Primer:

Considering Going Out of Network? Follow These 3 Tips to Pave the Road to Success

Published on Mon Apr 09, 2012

Be honest with your patients to ensure a smooth transition. More and more providers are questioning whether moving to an out of network situation with a payer -- or multiple payers -- is best for their practice. Becoming out of network has pros and cons that you'll want to weigh carefully before coming to a decision. If you're considering a move to becoming a non-contracted provider, follow these three steps to set your practice up for success. 1. Evaluate Your Existing Contracts and Patient Base Before your practice starts talking about becoming out of network with a payer, you should review your contracts. There are particular key areas to pay attention to as you go through the contracts, says Melanie Maycock, CCA, a billing consultant from Abrahams Medical Consulting in Romulus, Mich. According to Maycock, you'll want to look for the following things: Enhanced groupers Implant thresholds Procedure rates versus case rates [...]
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