An out-of-network provider reimbursement solutions company.
Howard Healthcare Group’s out-of-network medical billing services are administered by a highly specialized team with experience in overcoming the tactics and practices payors use to limit reimbursements to out-of-network providers. Today with more regulations on the horizon and ongoing changes in the industry, billing companies must possess extensive knowledge to establish the claims management process correctly to optimize revenue while complying with both Federal and State requirements.
Under the No Surprises Act (NSA), understanding the claim pathway at the outset and the documents required to be included with claims submissions will be critical. No longer can post-submission challenges sit idle for follow-up and timely, ongoing attention is needed to each and every claim. Based on our years of experience of challenging payors, we possess the skills and knowledge to navigate payor guidelines and the processes and requirements needed to successfully maximize revenue recovery for each claim.
Our services include:
From verification of benefits up to and including authorizations (i.e. GAP exceptions and single case agreements, when applicable) we will set your claims up correctly from the start to optimize payment. Your practice will be provided with proprietary documents for your patient intake packet to protect your rights as a provider to pursue fair payment. These documents include required Federal and State forms that will become even more critical in 2022 and beyond. Our claims analysts will work with your practice to seek to obtain patient’s health benefit documentation to mine relevant fee schedules or payment information specific to each patient and understand the plan’s impact on the reimbursement and appeal process. Advice and documentation will also be provided for regulatory compliance.
Modifiers, multiple procedure reductions, medical necessity and coding are some of the key factors that impact claims processing and reimbursement. Surgeons performing complex procedures are especially at risk of payment delays, underpayment or denials for errors and oversights when coding claims. Our team will review consult notes and operative reports to make sure clean claims are submitted to optimize initial payment recognizing that coding strategies can vary depending on the payor.
Our team of highly skilled negotiators work to maximize revenue as quickly and efficiently as possible including negotiating both before and after services are rendered. Our team knows how to leverage among other facts, our repository of historical payor payment data, and the documented representations made by the insurance company during the preservice process. We have extensive knowledge in working with third-party repricing companies to achieve maximum success for our clients. Experience matters and even in negotiations strategies are varied depending on the payor and/or repricing company.
We methodically appeal any claim that is not settled through negotiations. Our team will appeal and challenge medical documentation issues such as timely claim filing, claim denials for lack of authorization, procedure denials, and coding issues.
In the event a claim is still not settled after these initial efforts, we will initiate complex and post-appeal actions, at our expense, by utilizing our broader company resources under Cohen Howard’s legal division or services of other law firms and third parties. These complex appeals are the most comprehensive in the industry leaving no stone unturned and challenging payors on many fronts. We will appropriately exhaust all appeals to obtain a fair payment that is rightfully owed to clients.
Through these outside services, we will oversee the pursuit of complex appeals, prelitigation demands, arbitrations and litigation as needed to resolve payment disputes (please note litigation is handled on a case-by-case basis and only undertaken with prior approval by the client).
Out-of-network providers are often subject to insurance companies sending checks for payment directly to patients as a tactic to delay payment to providers. In addition to advising on best practices for collecting patient cost-sharing responsibility, our team will help to navigate collections from payors on misdirected checks to patients. Federal and State requirements have limited payor tactics in this area and knowing the requirements becomes critical to overall revenue management.
Throughout the claims management cycle, a systematic and timely process must be employed to ensure that claims are appropriately handled and to avoid any delays or denials for lack of timeliness. We aim to optimize payments at every opportunity presented to get providers fairly paid in an efficient manner.
Founded by Insurance Experts
Howard Healthcare Medical Billing Services is founded by commercial insurance experts with a keen understanding of ERISA. Our team is comprised of professional medical billers, coders and insurance specialists with a dedicated team handling our robust preservice and billing processes. We are able to optimize the true value of a claim by capitalizing on our collective knowledge of the patterns, practices and tactics the commercial health insurance industry uses to routinely restrict payment to medical providers.
Many billing and collections companies focus on volume. The more claims processed the more money is made by the billing operation even if the provider is being paid only a fraction of the billed charges. In addition, practices often allocate time and resources to pursue collections from patients for outstanding balances not paid by the payors. Our approach is vastly different than any typical billing and/or collections company. We focus on pursuing fair payment from the payors rather than patients by offering a sophisticated billing service that sets up your claims management cycle to optimize payment from the start. Providers are measured on many factors with patient satisfaction being paramount to a practice’s livelihood. Providers get into medicine to care for patients and end up being confronted with a multitude of administrative burdens that can adversely impact patient relations all in the pursuit of attempting to get fairly paid for services rendered. We are committed to helping providers get back to what they do best, practicing medicine.