Facing Insurance Audits as Out of Network Provider

1. Facing Insurance Audits as Out of Network Provider Medical Billers and Coders

2. According to the 2021 Milliman Report, more and more providers has preferred to provide healthcare services as Out of Network Provider provider. This Out of Network Provider utilization is much higher for mental health services than for medical or surgical services. Relaxed telehealth policies during the COVID-19 pandemic have offered more access to Out of Network Provider providers. Since the auditing of patient records has been increasing for in-network providers, it’s no surprise that insurance companies are scrutinizing Out of Network Provider claims more frequently as well. Even if you are not in-network with the patient’s insurance carrier or you do not accept insurance at all, you could still receive a request from the patient’s insurance company to review their records. If the patient submits a claim to the insurance company, then the company may verify that the services are being provided fulfill the criteria of ‘medical necessity or not. While you may not have a contract with the insurer, your patient does. Denying access to records may have serious ramifications for both your patient and you, so it’s important for you and your patient to understand potential consequences

3. Basic Tips on Facing Insurance Audits as an Out Of Network Provider • Understand Purpose of Audit • Obtain Patient’s Consent • Understand Record-keeping Requirements

4. The best way to stay prepared for insurance audits is to submit every claim carefully and maintain documentation to support medical necessity. For providers, it might not be possible to pay attention to revenue cycle functions at every claim level, as most of their time is utilized inpatient care. You can always take help from expert medical billing companies like MedicalBillersandCoders (MBC). We provide complete medical billing services including but not limited to charge entry, payment posting, accounts receivable management, denial handling, eligibility, and benefits verification, and provider credentialing.

5. Email : info@medicalbillersandcoders.com Fax no: 888-316-4566 Toll Free no: 888-357-3226 AddressWilmington, 108 West, 13th street, Wilmington, DE 19801Texas, 539 W. Commerce St #1482 Dallas, TX 75208