Medical Billing Services

Reimbursement Strategies for Out-of-Network Patients

Billing collections is one of the most unpleasant but fundamental processes that an in-house or outside medical billing firm must conduct on behalf of a medical practice. Without proper collections, the business aspect of any medical practice will fail. Among the different types of collections, medical offices collecting reimbursements from patients for out-of-network services or procedures are among the hardest to collect. It’s easy to understand: patients hesitate to turn out-of-network reimbursements over to their healthcare practitioners, healthcare practitioners hesitate to solicit reimbursements, and the healthcare practice always suffers financially as a result.

With these miscommunications in mind, there are strategies medical billing departments can employ to increase reimbursement collection rates, despite their disadvantageous position of being so far removed personally and financially from the patient. We will explore some of those strategies.

What’s Your Policy?

The only real way to ensure that patients understand the policy for collecting reimbursements from out-of-network providers or medical services is to spell it out. A well-defined, written, clearly visible and easily accessible policy greatly enhances the chance a patient will understand exactly what the procedure is for turning in these reimbursements. In addition, the medical practitioner has an enforceable set of guidelines upon which to act in all possible scenarios. The details can vary, of course, but the basic idea remains: the policy must state that the patient is required to turn in all reimbursements from insurers to the medical provider, and the patient must also agree to pay any charges not covered by insurance. The language of the policy must be clear, and easy to understand, in order to help the patient understand their responsibilities and make the policy more effectively enforceable.

Make Documentation Transparent

When a patient uses the medical services of an out-of-network provider, they often don’t know what they will be charged and how much they will eventually be required to pay. This can happen for a few reasons (including the above reason of not being aware of an ironclad reimbursement policy): an out-of-network medical provider often doesn’t bill a patient what they will bill an insurance company for their work or services, or the medical provider simply won’t have the time, interest, or bandwidth to explain the intricacies of billing to a patient.

Lack of transparency results in all sorts of billing problems that range from the more innocent – lost charges that reduce a practice’s revenue – to more insidious problems, like a practice double billing a patient for the same service or for services already rendered by a different medical provider. This double billing discrepancy is a form of medical billing fraud that can occur intentionally or unintentionally, but needs to be avoided, and can only be done with a clear, transparent fee structure that is presented to the patient. This needs to be outlined and presented to the patient before services are rendered, or the utility and chance of successful payment is greatly diminished. It is unreasonable to think a patient, when presented with faulty or incomplete fee structure information, will be more likely to pay what they owe in full.

Collecting Debt

The most unsavory part of medical billing is when a bill enters collections. If the proper steps to avoid billing discrepancies have been taken, and the bill still enters collections, the debtor or medical billing firm must take appropriate collection action. As a matter of appropriate procedure and good practice, good faith debt collection usually entails trying to contact the patient at least three times in a reasonable manner, whether by phone, mail, or electronic means. Trying to collect on a bill this way ensures you have followed your part to give the patient a reasonable chance to pay their balance. Also, following the aforementioned process increases the chances of avoiding increased debt owed by the patient and damaging the revenue of the medical practice. If three contact attempts have been made in good faith and have failed, proceeding to employ dedicated collections companies or filing suits through an attorney in claims courts are options of varying degrees of financial cost and success. Whether to sue the patient over the amount of the insurance reimbursement is a matter best discussed with an attorney versed in such matters, which should bring clarity as far as whether it is in the best financial interest of all parties involved.

All three of the above steps are important, and all, especially collecting debt, can be aided by the use of outside medical billing firms like Delphi Management Services.