Out of Network Billing At only 9.99% of Monthly Collection
We specialize in handling out-of-network Billing and reimbursement process for healthcare providers who are not part of a particular insurance company’s network. We ensure that providers receive fair and timely reimbursement for the services they have provided. We use our expertise and knowledge of the healthcare system and insurance industry to advocate for our clients and negotiate with insurance companies to reach an agreement on reimbursement. We also help the patients to understand what is covered by the insurance and how much they are responsible for paying. We will help you to focus on providing high-quality medical care without having to worry about the administrative and financial aspects of your practice.
Services We Offer
Getting reimbursement from health Insurances for out of network claims is not an easy task because Insurances prefer to pay contracted providers! To maximize your practice’s out- of- network profit you ’ll need a mate that understands the process of out-of-network billing and has the experience to overcome all the obstacles the insurances will put in the way of your payment.
At Advanced RCMS, we offer comprehensive out-of-network billing solutions to ensure timely reimbursement for your out-of-network medical bills. Our services include:
INSURANCE NEGOTIATION
We negotiate with the insurance companies on behalf of the provider to help ensure that they receive fair reimbursement for the services they have provided. We also advocate for the provider in disputes or appeals regarding reimbursement.
PATIENT STATEMENTS
Our team sends clear patient statements that are easy to understand, for any out-of-pocket expenses that the patients are responsible for, such as co-payments, deductibles, or balance billing amounts.
FINANCIAL REPORTING
You will be provided with regular reporting on the status of claims and reimbursements. We will also provide you with data analysis each month to help you understand the financial health of your practice.
COMPLIANCE
Our experienced out-of-network billing team will help you to stay compliant with the insurance company, healthcare laws and regulations, and state balance billing laws to avoid any potential legal issues.
Why Outsource Advanced RCMS?
Our team of professional collectors perform each necessary step to ensure maximum reimbursement rates for out-of-network claims including gathering all relevant information, negotiating with the adjusters and providing them all supporting evidences and considering to hire an attorney. We will ensure that your out-of-network billing and reimbursement processes are handled effectively and efficiently, freeing up your time to focus on what’s most important—providing quality patient care.
care features
Cost-effective Solutions
Expertise
Our out-of-network billing team specialize in claim negotiations and has the expertise and experience to navigate the complexities of out-of-network claims and ensure that you receive the maximum reimbursement.
Increased Efficiency
With our specialized negotiators handling your out-of-network claims, you will see improved efficiency and faster payment processing.
Time savings
Outsourcing Advanced RCMS billing solutions frees up your staff to focus on providing highest level of patient care, instead of dealing with the administrative tasks associated with out-of-network claims and reimbursement.
Cost-effective Solutions
Negotiating out-of-network medical billing claims with insurance companies can be a complex and time-consuming process, but it can be done effectively with the right approach. Here are some of the steps that we perform to ensure a successful claim negotiation with Insurances.
Understand Insurance contract
We Review insurance contract carefully to understand the terms and conditions of out-of-network medical billing, including the reimbursement rate and any restrictions.
Gather supporting documentation
We Collect all relevant documentation, including medical records, treatment notes and bills and previous communication history with the Insurance adjusters to support your case.
A Polite and professional Approach
Our skilled out-of-network billing teams use a professional demeanor and a respectful tone when negotiating with insurance companies to go a long way in achieving a favorable outcome.
Presenting a compelling argument
We explain the reasons why we believe the insurance company should pay a higher rate, and also, we emphasize the quality of care you provided and any exceptional circumstances that may have impacted the cost of care.
Being open to compromise
Our team is well prepared to discuss alternative payment arrangements with Insurance companies or to consider negotiating a lower rate in exchange for a faster payment.
Legal help
If the case is not resolved through negotiations, we consider seeking the help of a healthcare attorney which specializes healthcare law regarding medical billing.
At Advanced RCMS, we believe that key to successful negotiations is to be well-informed, professional, and persistent. By following these tips, we increase chances of resolving the issue and receiving fair compensation for your services.
Value Added Services
Latest Software
We process out-of-network claims using latest technology based software that offer out-of-nework billing service, such as, AdvancedMD, Kareo, NueMD, Practice Fusion, TheraBill, etc,. It allows us to properly manage claim submissions and follow ups, track payment status, and monitor the accuracy of billing information.
24/7 Support
We provide 24/7 support to our clients. Our team is responsive, helpful, and dedicated to ensure that clients receive the support they need to get maximum reimbursement for unpaid out of billing claims quickly and effectively.
Data security
At Advanced rcms, we take the privacy of our clients and their patients very seriously. We understand that the information we handle is sensitive and personal, and we protect your personal information through the use of encryption, such as the Secure Socket Layer (SSL) protocol.
Reporting and analytics
We provide our clients with monthly reports and analytics, so they can track the progress of their out-of-network bills and make decisions accordingly about their billing procedures.
Choosing The Right Software for Out-of-Network Billing
For healthcare providers, out-of-network medical billing can be a complex and time-consuming process. With Insurance companies often paying significantly less for out-of-network services, it’s essential for us to use effective medical billing software to ensure we receive maximized reimbursement for our clients’ out-of-network bills. We use the best out-of-network medical billing software currently available in the market including:
AdvancedMD is a comprehensive medical billing software that includes features for out-of-network billing. The software is user-friendly, with a streamlined interface that makes it easy to navigate and manage patient billing information. AdvancedMD also integrates with electronic health record (EHR) systems, which can help providers streamline their workflow and improve their overall billing accuracy.
Kareo is a cloud-based medical billing software that offers out-of-network billing solutions, patient portal, and appointment scheduling. With Kareo, providers can access patient information from anywhere and easily submit claims to insurance companies. Kareo also offers robust reporting features, which can help providers track the status of their claims and monitor their overall billing performance.
NueMD is a web-based medical billing software that includes features for out-of-network billing, insurance claims, and patient management. The software is designed to be highly scalable, with the ability to handle a large volume of patients and claims. NueMD also offers advanced reporting capabilities, making it easy for providers to track their financial performance and monitor their billing process.
Practice Fusion is an electronic health record (EHR) system that also provides out-of-network medical billing solutions. With Practice Fusion, providers can manage their patient information and billing information in one place, streamlining their workflow and improving their overall efficiency. Practice Fusion also offers a patient portal, which can help providers communicate with their patients and improve patient engagement.
TheraBill is a cloud-based medical billing software that specializes in out-of-network billing for behavioral health practices. The software is designed to be easy to use, with a user-friendly interface that makes it simple to manage patient billing information. TheraBill also integrates with EHR systems, making it easy for providers to transfer patient information between systems and improve their overall billing accuracy.
One of our medical billing specialist will communicate with you to choose the best out-of-network billing software for your practice depending on your specific needs and requirements. When choosing a software, it’s important to consider factors such as cost, ease of use, integration with EHR systems, and reporting capabilities. With the right software in place, we streamline your out-of-network billing process and improve your reimbursement, so you can focus on providing high-quality care to your patients.
pricing
The Best Solutions
for Our Clients
Contact us today to schedule a consultation and learn more about our pricing and the comprehensive out-of-network medical billing services we offer. We are committed to providing our clients with the highest level of service and support, and we look forward to helping you achieve your billing goals.
Faq
Freequently Ask
Questions
Out-of-network medical billing is a process where healthcare providers bill insurance companies for services rendered to patients who have insurance plans that do not include the provider in their network.
We determine the reimbursement rate for out-of-network services by reviewing the patient’s insurance plan, negotiating with the insurance company, considering industry standards and local market rates, and consulting with the billing experts at Advanced RCMS.
At Advanced RCMS, the out-of-network claims are submitted to the Insurance companies by careful attention to details and a thorough understanding of the patient’s insurance plan, including the benefits and limitations of out-of-network coverage, and accurately coding and billing the services rendered, while following up on denied claims and appealing as necessary to secure payment.
The process for appealing denied out-of-network claims is similar to the general appeals process, and involves reviewing the reason for denial, correcting any errors, resubmitting the claim with supporting documentation, negotiating with the insurance company, and appealing the decision through a formal appeals process if necessary, while consistently documenting all steps taken.
Providing a clear and detailed breakdown of charges for out-of-network services to patients involves breaking down the costs into individual components, such as the cost of the service, any supplies used, and any applicable taxes or fees, using clear and concise language, and providing a comprehensive and easy-to-understand bill or statement, while also clearly communicating the patient’s expected co-payments and deductibles and any financial responsibilities related to out-of-network services.
Communicating with patients regarding their responsibility for out-of-network charges involves being clear and transparent about the expected cost of services, discussing the patient’s insurance plan and coverage options, explaining the potential financial impact of choosing an out-of-network provider, and clearly outlining the patient’s co-payments, deductibles, and any additional financial responsibilities.
At Advanced RCMS, we manage and track patient payments for out-of-network services by using a robust medical billing software, implementing effective follow-up procedures, and consistently reconciling patient accounts to ensure accuracy and timely payment, while also being aware of and adhering to any additional financial responsibilities or limitations related to out-of-network services.
We maintain confidentiality and compliace with HIPAA regulations by implementing strict security measures, such as encryption and secure storage of patient information, training employees on HIPAA requirements, regularly reviewing and updating policies and procedures, and ensuring that all third-party vendors also comply with HIPAA regulations.
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