1. The days of out-of-network are over. Not only are the days of out-of-network not over, but out-of-network will continue to grow as a strong force, Mr. Bartos said. Given significant growth in PPO enrollment and more people insured than before, out-of-network services are on the rise. “The real reason by far that out-of-network is here to stay is that people want it,” Mr. Bartos said. “People want to have the choice of seeing the providers they want to see. A lot of people want to have that choice and are willing to pay for it.”
2. Being 100 percent in-network maximizes reimbursements. Mr. Bartos said out-of-network reimbursements can actually be higher than in-network reimbursements. However, he warns against transitioning full-fledged to out-of-network services. “The wise provider would do a detailed analysis of what’s happening in their marketplace and adopt a hybrid approach.”
3. We’ve got it covered. Instead of solely relying on individual policies regarding out-of-network reimbursements, facilities should seek experts and allocate resources to continually monitor how they are doing. “If you take a close look, you can identify places where you don’t have it quite covered,” Mr. Bartos said.
More Articles on Coding, Billing and Collections:
Intermedix Acquires Medical Billing Operations
Selecting a Medical Billing Partner: 3 Tips for Physician Practices
5 Statistics on Operational Changes Physicians Plan on Implementing in 2014
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
