decisionhealth Newsletters, Part B News - 2013 Issue 6 (June)
Ask a Part B News expert: Charging out-of-network patients
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Article Overview
This Part B News Q&A addresses a common office billing question about offering reduced prices to out-of-network patients for an initial visit. It explains, at a high level, how payer type, deductible status, and allowable amounts can affect what the practice charges and what the patient may ultimately owe. The article is relevant to physician offices, billing staff, and practice managers who handle patient financial policies and insurance interactions.
Why This Topic Matters
Billing practices for out-of-network patients can affect patient collections, deductible application, and later payer payments. Understanding the general considerations helps practices set policies that are consistent with their contracts and patient communication processes.
Article Sections
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Ask a Part B News expert
A reader question is presented about reduced pricing for an out-of-network office visit and the potential effect on insurance payments.
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Expert response
The response discusses general out-of-network billing considerations, including payer relationships, patient responsibility, and how discounts may interact with later allowable amounts.
What You Will Learn
- How out-of-network status can affect general billing relationships with payers
- Why deductible and allowable concepts matter in patient billing policies
- How practices may think about discounts and patient communication for self-pay or out-of-network visits
- What kinds of payer arrangements can influence whether a balance remains after payment
Who Should Read This
- Physician office staff
- Medical billers
- Coding and reimbursement professionals
- Practice managers
- Revenue cycle staff
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