Out of network claims processing is the basis for surprise billing. Your practice has probably changed to accommodate the regulations on out of network providers spawned by the No Surprise Bill. This shift, while providing patients with additional rights, also provides options for you.
Out of network varies from payer to payer. For individual practices and organizations like yours, payers may decide you’re in the network one year and not the next. If you’re determined to be in a specific network, it specifies a pay rate, among other things.
Out of network occurs when your practice does not have an agreement with a particular payer. In these cases, the payer often sets a percentage they’re willing to cover, and the patient is responsible for the rest. These cases can be challenging on all sides.
Out of network bills can be ordinary or challenging, depending on the other payer. In some cases, your practice may be paid promptly at an acceptable rate. In others, you may need to engage in the NSA IDR process to ensure you’re compensated fairly.
However, this process can be complex and time-consuming. Patient notification, claim submission, negotiations, NSA IDR, collection, and more can slow the payment to your practice. Depending on the circumstances, it can even affect your RCM goals. Ultimately, OON medical claims processing can be costly.
The No Surprise Act created a notification requirement regarding specific circumstances and insurance. This requirement generally serves patients well; many report improved experience within healthcare ecosystems.
However, out of network reimbursement has become more complex for your practice. Getting paid for medical services often requires additional steps and negotiation with the payer, which is frequently uncompensated. This can affect when the payments come in and may even be significant enough to impact the revenue stream.
NSB can handle out of network claim collections using our experienced team and cutting-edge technical tools. We also offer options to optimize your practice’s operations around out of network claims for the future and with an eye on maximizing your practice’s collection speed.