Out-of-network billing is a bit like stepping on a slippery stone in the dark. It is notorious for leaving providers severely underpaid by the payer. The No Surprises Act (NSA) came into force on January 1, 2022, to protect patients from receiving lofty balance bills after receiving the services of an out-of-network provider in an Emergency Room. It was meant to keep those sneaky bills from ruining the patient’s day. And while it has helped the patients to a great extent, out-of-network billing still feels like untangling last year’s Christmas lights for healthcare providers.
Now, the million dollar question here is, do you still prefer to handle these billing headaches on your own or delegate this task to a professional OON billing service provider? The best move to make is to understand the OON billing challenges, and the pros and cons about outsourcing this specific type of billing.
Let’s begin with the vital challenges and some stats about out-of-network billing.
Why Does Out-Of-Network Billing Continue To Haunt Healthcare Providers?
OON billing remains a big headache for most healthcare providers even after the NSA. Many providers don’t fully understand the nuances of collecting from OON claims. They now have to deal with more paperwork and longer wait times to get reimbursed. Payments are often delayed, and some providers have seen their reimbursements drop by nearly 40% since the law started.
The Independent Dispute Resolution (IDR) process – which constitutes the heart of collecting from OON claims – is a well recognized but less understood process. Ever since it came into action, over 490,000 disputes were filed between April 2022 and June 2023 — way more than expected. Many of these disputes dragged on for months, leaving payments stuck.
On top of this, insurers pay less than providers expect, hurting their income. The fees to arbitrate these disputes have also shot up. To make matters worse, the NSA doesn’t cover everything — ground ambulance bills, for example, are still a problem. All this makes out-of-network billing a confusing and stressful mess. That’s exactly why having a good third-party billing partner can help.
Let’s explore the benefits of using a third-party out-of-network billing provider.
The Major Pros of Hiring an OON Billing Partner
Expertise with Complex Regulations
Out-of-network billing is not like regular billing. It involves extra rules, dispute processes, and legal requirements. A specialist third-party billing company knows these rules inside and out and stays on top of all provisions under the NSA.
Faster Dispute Resolution Support
The IDR process is slow and needs a solid approach if one hopes to win. If you try to handle it alone, you’ll likely face unfavorable outcomes. A billing company has specialists who deal with these disputes daily. A professional OON billing company has a dedicated team, comprising not just expert billers and coders, but also legal experts who know how to file for arbitration in a manner that will yield the best results.
Reduced Administrative Burden
Out-of-network billing creates extra work for your team. There’s paperwork, claim tracking, dispute filing, payer follow-ups, and more. A third-party company makes your life easy by taking off the load from your shoulders, freeing you from having to worry about collecting from your out-of-network encounters.
Better Cash Flow Management
Delayed payments hurt your practice. Many providers face cash flow problems because of unresolved out-of-network claims. An experienced OON billing partner can reduce this delay significantly for you and help you collect your dues from payers. In other words, they help you get paid faster and keep your revenue stream steady.
Stronger Denial Management
The bitter truth about out-of-network claims is that they are often denied or severely underpaid. Almost 37% of OON claims were denied in 2023, whereas in-network claim denials were 19%. A billing company has dedicated denial management teams. They analyze denied claims, fix issues quickly, and resubmit them. This helps reduce bad debt and revenue loss.
Help with NSA Compliance
The No Surprises Act lays down some strict provisions, and staying compliant with them is absolutely necessary. The same applies for IDR arbitration too. What is equally important is staying abreast with changes in the process. For example, administrative fees for dispute resolution jumped by 600% at one point. A professional billing company tracks these changes closely. They adjust your billing processes to stay compliant and avoid penalties.
Access to Advanced Billing Methodologies
Professional out-of-network billing service providers leverage advanced methodologies, deep analysis, and specialized skills to ensure the best outcome for providers. They make claim tracking, reporting, and dispute management easier and more effective. Providers, as a result, get better visibility into their arbitration status.
Choosing the Right OON Billing Specialist
Collecting from OON claims is not an easy task. Payers tend to remain adamant about their QPA (Qualifying Paying Amount) offer and are notorious for refusing to pay the provider’s charges. IDR arbitrations can be tricky too. If a solid case – supported by adequate documentation and justification for the provider’s bill – is not built, the arbitrator can pass the judgment in favor of the payer.
Thus it is evident that collecting from out-of-network claims requires deep familiarity with the NSA, billing and coding acumen, and some amount of legal assistance too. And these are the kinds of qualities and personnel you would find in an ideal OON billing company. Expertise in AR and denial management, and knowledge of payer-side strategies (especially in claim adjudication) are an added bonus.
Should You Hire a Third-Party Billing Partner?
Yes — if you want to simplify your out-of-network billing, improve your chances of getting your bills paid in full, and stay compliant with NSA rules. Out-of-network billing has only become more complicated since the NSA took effect. Trying to handle all this in-house can easily get overwhelming for your staff, leading to mistakes. But a deft billing partner takes that weight off your shoulders. OON billing experts know how to deal with payment discrepancies, reduce bad debt, and help you get the most out of IDR arbitrations.
When it comes to finding expert support in OON billing, look no further than CollectionPro Services LLC. Hire us and enjoy benefits like:
- Handling of every IDR case by our in-house, state-licensed lawyer with experience of over 10,000 similar cases
- Full advancing of administrative ($115) and administrative (up to $1,200) fees, refundable only after a favorable arbitration outcome
- Flat 10% contingency based fee, payable only if the provider wins, and no hidden charges
- Multi-payer expertise, spanning both federal, state and commercial insurers
- Transparent reporting – available weekly and on-demand – that clearly show the status of the recovery process
CollectionPro makes recovering your dues simple and stress-free. Contact us today and watch us turn all your denied and underpaid claims into bona fide revenue.
