Participation: Successfully Collect for Services When Your Practice Does Not Participate

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains broad office workflow and patient-financial-policy considerations for practices that choose not to participate with some or all insurance payers. It covers general topics such as patient communication, collecting payment at the visit, setting fees, claim submission considerations, and next steps when payment is not received. The content is aimed at coding, billing, and practice management professionals who handle non-participating payer scenarios.

Why This Topic Matters

Non-participating arrangements can create extra administrative burden and collection risk. Understanding the article helps practices evaluate whether the guidance is relevant to their billing policies, patient checkout process, and collections workflow.

Article Sections

  1. Get the Patient to Sign a Statement

    Discusses patient communication, financial-policy notices, and collecting insurance information as part of the office process for non-participating payer situations.

  2. Collect While the Patient Is In Your Office

    Reviews timing considerations for obtaining payment during the visit and factors that can affect whether upfront collection is practical.

  3. Know What Fees You Should Charge

    Addresses broad fee-setting considerations for services billed outside a participating payer arrangement and general claim/payment handling.

  4. When All Else Fails, Turn to Collections

    Covers general escalation options when payment is not received, including office follow-up and outside collection pathways.

What You Will Learn

  • How non-participating payer arrangements affect office collections workflows
  • How practices communicate payment expectations to patients
  • How collection timing can influence follow-up burden
  • How practices think about fee setting and claim handling in non-par situations
  • What general escalation paths may be used when patients do not pay

Who Should Read This

  • Medical billers
  • Certified professional coders
  • Practice managers
  • Revenue cycle staff
  • Healthcare office administrators

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