Service Detail

Out Of Network Billing Services

Claims that have been rejected, denied and/or underpaid are carefully reviewed and appealed as quickly as possible. HMS USA utilize several levels of appeal resolutions. Prompt posting of all payments received and monitoring reimbursement. We accurately interpret and posts insurance and patient payments to maintain maximum reimbursement.

Billing for freestanding ERs and Micro Hospitals require specialized knowledge of Payer Negotiation. We negotiate aggressively on your behalf, thus increasing your revenue while your focused efficient facility management.

If your Out-of-Network biller cannot answer these questions, you may be losing revenue.

What is ERISA, How we can process claim in ERISA?

What are multiple procedure reductions and when is it okay for carriers to apply them?
What is MNRP, MRC1 and MRC2?
What is LOP?

What are third party pricing companies?
When, if ever, is it okay to negotiate rates for out-of-network claims?
Can the same surgery performed by the same non-par Doctor on two different patients with the same insurance policy have two completely different allowed amounts? If yes, how?
Which carriers send checks to the patients regardless of whether the provider accepts assignment?
What is catastrophic coverage?
Can an E&M code be billed within the global period? If yes, how? 
Can a surgical procedure be billed within the global period? If yes, how?
What are the three components of an E&M code that must be documented?
If two surgical codes are legitimately mutually exclusive, which one is supposed to get paid?