Billing > Facility Billing

a question on out of network

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Pay_My_Claims:
if OON, you really need to have your ducks in a row especially your UP FRONT COLLECTIONS!!

PMRNC:

--- Quote ---I do mosly cosmetic, so the insurance work I do, I look upon as gravy.
--- End quote ---
   :-\ :'(


--- Quote ---I am trying to explore billing a facility fee for my AAAASF certified OR but have not made much progress as noone seems to know the rules or answers to make it work.
--- End quote ---


So you want to DE-Credential with carriers but bill facility and professional component? Sure you can. Assuming you have setup a proper legal structure to do so you can. Your facility charges will get billed using UB form and proper revenue codes and your professional fees will still be billed on CMS 1500   When out of network your not dealing with fee schedules HOWEVER your dealing with something I think is worse.. Reasonable & Customary or U/C Usual and Customary, that means if you bill out a Surgery at $10 K the insurance tells you what's R&C U&C and the rest is patient responsibility.. Don't know about you but I'd rater take my chances with a fee schedule than to ask the patient to pay $5K and end up spending most of your time dealing with collection agencies. Sure you can appeal and you might win some, lose some, get a little more, but again, more time = More money out.
So while it might seem like gravy to you, make sure you have really ran the numbers, gone over the fee schedules, the allowable and the patient aging reports for the past year (at least).  Now as far as the facility. .I would imagine you have to meet a lot of special requirements in order to do this so I would suggest a good attorney to guide you.

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