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Podiatry Coding & Billing Alert

Billing Primer:

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

Published on Mon Mar 05, 2012

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 PPOsReduction of state mandated fee schedulesClaims filing limitationsPenalty for [...]
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