Facing Insurance Audits as Out of Network Provider MBC discussed basic tips on facing such insurance audits as an out-of-network provider 1. Understand Purpose of Audit 2. Obtain Patient’s Consent 3. Understand Record-keeping Requirements To know how we can add value to your medical billing operations, contact us at info@medicalbillersandcoders.com/ 888-357-3226 Read More: https://bit.ly/3qGUyEM #insuranceaudits #medicalbillingoperations #outofnetworkprovider #facinginsuranceaudits

1. MEDICAL BILLERS AND CODERS
Facing Insurance Audits as Out
of Network Provider

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.

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