tci Outpatient Facility Coding Alert - 2017 Issue 7

The In's and Out's of OON Billing

Check out these best practices for reducing your FCA risk if you bill OON. Should your facility participate in out-of-network (OON) billing? While some providers are forced to bill OON because health plans won’t enter into a network agreement, other providers choose to. Because payers usually pay OON claims at a higher rate than in-network claims, it often means increased revenue. But OON billing — healthcare provider billing without a payer contract — could also be a big liability, leading to increased denials and more alarmingly, charges of false claims. “To me, as a lawyer, out-of-network billing...

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