3 Best Practices to Maximize Your Out of Network Collection Revenues

In an ideal world, doctors and the health care provider community should be focusing only on the wellbeing of the patient. However, physicians in existing times, they also need to manage billing while ensuring quality care. The billing has become complex and cumbersome especially for patients without or with limited third-party insurance. Many hospitals and health care clinics choose to serve out-of-network patients. A patient is considered “out-of-network” when the hospital or the physician’s clinic does not have a contract with the patient’s third-party insurance company.

A slack could cause significant loss of health care revenues and inconvenience to the patients caused by an increased out-of-pocket expense. The situation gets worse when the billing support staff at the clinic is unaware of how to bill for out-of-network services. Professional billing and coding firms have the desired skills to help you with out-of-network reimbursements.

Here are a few steps that can help increase out of Network collection:

1. Preparedness – Doctors/hospitals must have a computer-based intelligent data capturing tool to enter/modify all relevant information from the new and existing patients. This would allow them to have up-to-date patient insurance information and coverage at all times. This proactive step can help preempt possible billing issues against the check-up and treatments. Hospital facilities must know about the payer’s policies and trends before offering treatments.
2. Acting fast – After a preliminary diagnosis and patient willingness to go for the treatment, the health care facility must assess the condition of the patient and their overall treatment requirements, to compute the patient’s possible treatment cost.
3. Transparency – Maintain the highest degree of transparency amongst all three parties involved (physician/hospitals, patient, and insurance company). The health care facility must make the patient fully aware of the amount that will be covered by the insurance and the costs that they need to pay.

Let the patient choose the service consciously – In addition to transparency, the health care facility should give a break-up of the treatment cost. An example highlighting some immediate diagnoses and medical treatment can help the patient to opt for, and decide to go back to his/her insurance-covered facility for treatment.

Identify any weak spots and training needs. The care centers must invest time and effort in educating the staff around recent billing trends. The staff must be fully aware and trained around billing processes and the pitfalls to avoid.

Be very persistent in your efforts while maintaining the proper use of resources effectively and efficiently. Find people who have experience and take their advice and expertise on how to handle such tactics. Avoid any missed or mixed revenue as much as possible throughout the entire collection process.

Expand your services and your authority – Build a strong relationship with your patients. Transparency can help build trust over time, and help avoid the loss of revenues. Discuss with your patients about payment options and possibilities, before providing the specific health care services.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com