Full Revenue Cycle Management for Out-of-Network providers. VGA oversees correct coding, pricing, claim submission, payment posting, third party fee negotiation, provider appeals and follow up for all insurance claims. VGA also acts as a customer support/liaison to out-of-network patients for insurance issues.
Can Your Biller Answer These Questions?
What disclosure/consent forms do you need to comply with state and federal No Surprise Billing Laws?
What is MNRP, MRC1 and MRC2?
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?
Our quintuple certified professional coding manager oversees the proper CPT coding of submitted operative reports. This includes co-surgeon and assistant coding, bundling, multiple procedures, technical vs. professional components, anesthesia, drug and DME HCPCS, etc.
Third Party Pricing Companies
Being on the front lines of out-of-network billing, we identify changes in reimbursement and the use of third party pricing companies in real time, and employ solutions to manage them. From Zelis to Multiplan and Data Isight, VGA handles the intricacies of out-of-network settlement negotiations to maximize reimbursement.
Rates and Fee Schedules
How much is too much, and is there such a thing? We lease out-of-network pricing data directly from FairHealthConsumer.org. This provides transparency, and most of all, establishes trust with your patients. Our patient cost-share strategies keep our clients compliant with the federal and state No Surprise Billing laws and Balance Billing requirements. We have also completed several successful single case agreements for patients with limited or no out-of-network benefits.
Not all reimbursements can be directly deposited into your bank account by insurance carriers. Plans with anti-assignment clauses still send the insurance checks to the patient/insured, which can easily be cashed by a staff member and marked as paid. VGA has experience uncovering over $200,000 of embezzled funds resulting in prosecution and conviction.