Practice Management Alert

Billing Primer:

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

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 BaseBefore 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 groupersImplant thresholdsProcedure rates versus case ratesSilent PPOs Reduction of state mandated fee [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Practice Management Alert

View All