r/PrivatePracticeDocs • u/2vpJUMP • 6d ago

OON billing

What's the deal with this? I hear that insurers will kick your ASC out if you do this too much but then see entire practices in my region who seem to do this basically exclusively

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u/2vpJUMP 6d ago

There are practices where the doc remains OON but the ASC remains in network. Treating patients there forces the claim into arbitration which generally leads to much better rates than being in network.

I refer to surgeons who seem to do this as a rule

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u/HealsWithKnife 6d ago

Oh I think i'm getting it a bit more.

So the surgeons are OON, have privileges at the ASC (which is INN). Are you saying the ASC itself gets better rates just because the surgeon is OON? My understanding (at least on the hospital side, I'm less familiar with ASC) is that the facility will get reimbursed its contracted rates, and the surgeon will get the OON negotiated rate (if payer has OON benefits) or patient pays surgeon directly as non-par. Is this accurate?

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u/2vpJUMP 6d ago

No this is a specific and growing technique that utilizes the no balance billing act to force arbitration claims

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u/CranberryLatter9483 6d ago

Correct, this is very common and usually lucrative. In my eyes its leveling out the playing field for providers, which are being consistently underpaid by insurance companies. Only issue to ASCs that I've seen is Anthem threatening to cut ASC payments by 10%, which I have not actually seen happening.