Are You Ready to Take Your Practice Out-of-Network?

Not many providers enjoy jumping through insurance company hoops in order to receive payment, and yet for most, it seems to be a fact of life—or at least a fact of doing business. There is another way, though. You could take your practice out-of-network. But it’s not a decision to enter into lightly. You’ve got to be ready. Read on to find out if you are.

You’ve done your research.

First things first. You should know what going out-of-network entails: the main difference being that out-of-network providers have a relationship with their patients, not insurance carriers. This means that in most cases you’ll receive payment for your services directly from your patients—and they’ll receive out-of-network payment from their insurance company if certain conditions are met.

However, not all patients want to be on the hook financially for services their insurance company will directly pay for elsewhere. So in order to transition out-of-network without hemorrhaging money, the APTA says you’ve got to be sure that “your community will support this type of practice.” And that requires some market research. In addition to surveying what other physical therapists are doing in your area, the APTA suggests asking current and prospective patients their opinions about out-of-network services in either one-on-one interviews or focus groups. During these sessions, you also should collect information on what other services your patients have access to, so you know for sure that you can effectively compete—which brings us to our next point:

You know your key service differentiators—and you know how to market them.

If patients can receive equal-caliber physical therapy services from an in-network provider, most will go that route. After all, it can be a lot less work for the patient. That means you’ve got to work extra hard to ensure your services go above and beyond what’s available elsewhere. According to the APTA, “The best strategy is to compete in as many areas as possible, including clinical skills and expertise, customer service, location, accessibility, hours, and reputation.” In other words, if you’re looking to stand out, you’ve got to be good—no, great—at everything. Then you’ve got to know how to market yourself, so the potential patients in your community know who you are and what you bring to the table. (For a comprehensive guide on how to effectively market your practice to today's PT patients, download our free modern marketing e-book.)

If marketing isn’t your thing, the APTA recommends hiring a social media and marketing expert to ensure your message is making its way to the right masses, and thus generating new business. You also might want to consider hiring a website designer and practice consultant.

You’ve brought in an expert.

Speaking of experts, the APTA suggests seeking guidance from people who are professionals in accounting and law: “Discuss your plans and seek advice from your business attorney and financial advisor/accountant when considering this change.” After all, the financial buoyancy of your practice is on the line here. You should be sure that  you’re in a position to take on this change—and that when you do, you’re able to maximize your out-of-network billing. And that might mean bringing in a billing consultant as well. William Wendt, CEO of Castlerock Management Corp., urges out-of-network providers to learn the difference between Accept Assignment and Out-of-Network claims. Wendt also recommends:

• Checking all patients’ out-of-network benefits to ensure you understand them before providing care
• Providing patients with financial policy information so they understand their responsibilities
• Complying with all healthcare laws
• Requesting that patients follow up with their insurance companies to receive out-of-network payment
• Setting clear guidelines that “balance ethics with business considerations” for patients with financial need

You’ve talked it over with your colleagues.

If referrals make up a large portion of your business, the APTA says you should consider asking referral sources how you going out-of-network might impact the frequency of their referrals. You also should discuss your plans with colleagues, patients, and payers—and give everyone enough time to adjust to the upcoming changes.

If you’ve done all of the above, you may very well be ready to take your practice out-of-network. Want to learn more about a real-life cash-based practitioner? Check out Ann Wendel’s blog on billing for cash-based practices.

Have you already taken your practice out-of-network? Share your story—and advice—in the comments section below.

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