The short answer is yes, with caveats.
If by the question you mean that you can have a less than rigorous adherence to a claims and appeals process and still get much from your out of network efforts, the answer is, decidedly, no.
If by the question you mean that you can have the same out of network claims process that you’ve been using for a decade or more, than the answer is, unfortunately, no.
If by the question you mean that you have time and expertise to offer your best-in-class surgery center and a quality out of network claims and appeals process that gives you a return on your investment, the answer is, nearly impossible.
And there lies the challenge for surgery centers and physician owners. Due to the burdensome nature of developing a highly functional out-of-network claims and appeals process that consistently optimizes reimbursements and mitigates risk, many have understandably given up on out-of-network billing. There are solutions in the current reimbursement climate, but it’s nearly impossible for a surgery center to have the resources to continue to do what it does best (treating patients) and take the time and resources to develop a legally vetted out-of-network claims and appeals process that keeps insurers accountable to their plans and to the law so that you obtain proper levels of reimbursement. Contego does this and only this, full-time. There’s no way we could ever obtain the skills and resources to provide high quality surgeries – and we don’t expect to. That’s your specialty!
Out-of-network billing is still viable but it requires precision and daily attention to a high level of process detail – just like running a surgery center. Contego has taken the time over several years to develop one of the most thorough processes in the industry. Here’s what that process entails, in a nutshell.
Contego Optimizes Providers’ Out of Network Reimbursements Through
- Predictive modeling
- Highly effective deductible and co-insurance management
- Expert application of the claims and appeals process
- Pinpointed utilization of legal resources
Contego Mitigates Risk Through
A command mastery of all aspects of federal and state law coupled with a highly analytical predictive approach allows providers to focus on delivery of care while Contego focuses on financial returns.
- Rigorously ensuring compliance with federal and state law
- Stellar patient education and advocacy
- Continual engagement with top healthcare attorneys
Yes, a systematic, strategic, detailed, legally thorough out-of-network claims and appeals process can be an excellent way to obtain the reimbursements you need to maintain and grow your surgery center. But in the current reimbursement climate, it takes the same level of attention and intention that it takes to run your surgery center.