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ERISA: Are Out-of-network Providers Protected?

Posted on August 12, 2019 by CPC Exam Medical Coding Updates

Implement an enforceable assignment of benefits and protocols to protect providers against insurance underpayment and patient theft. Most members and contracted providers expect and/or take for granted Employee Retirement Income Security Act (ERISA) of 1974 law and assignment of benefits (AOB). But for non-participating (non-par) providers, the ability to receive insurance reimbursement directly, get an […]

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Get Over the Pitfalls of Out-of-network Surprise, Balance Billing

Posted on April 4, 2019 by CPC Exam Medical Coding Updates

Hurdles set by commercial carriers require out-of-network groups to tighten billing management and foster full financial transparency. Most non-participating providers learn that out-of-network reimbursement can be higher than in-network reimbursement. The two drawbacks to remaining out of network — higher patient out-of-pocket costs and exclusion from participating provider listings — may be remedied by waiving […]

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Court Upholds Ruling in UnitedHealthcare Out-of-Network Case

Posted on February 1, 2019 by CPC Exam Medical Coding Updates

The Eight Circuit Court of Appeals upheld a lower court’s ruling regarding out-of-network payments by UnitedHealthcare (UHC). How Ruling Got Started UHC has a policy of offsetting payments for patients in a different plan when they are trying to recover what they considered an overpayment. These policies were put into effect in 2007 and were […]

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Medicare primary and we are out-of-network with secondary

Posted on July 4, 2018 by CPC Exam Medical Coding Updates

If the secondary payer does not pay because we are out-of-network with them (either they deny the claim or apply it to a large out-of-network deductible), are we allowed to write off the co-insurance since the patient would not have had to pay it if we had been in-network with the secondary?

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Tag Archives: outofnetwork

ERISA: Are Out-of-network Providers Protected?

Get Over the Pitfalls of Out-of-network Surprise, Balance Billing

Court Upholds Ruling in UnitedHealthcare Out-of-Network Case

Medicare primary and we are out-of-network with secondary