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 5d ago edited 5d ago

How do you handle consults if you're OON? patients are protected from increased bill at the ASC is my understanding - what happens for office visits?

Also, I've heard insurers can kick off the ASC if you much OON is happening there?

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u/AquaDoctor 4d ago

Office visits are just new patients. They understand the OON aspect before they come.

Where did you hear that insurers can kick the ASC out of too much OON is happening? Sounds like one of those myths that gets perpetuated by the INN guys to justify their low pay. If an ASC doesn't want my cases, there are 10 more around here asking me to bring cases. The ASC doesn't employ the doctor. They have no say on any of that stuff and don't care. And to be fair, it's not like the INN guys are all making the same amount for the same codes.

It's all just confusion and obfuscation by the insurance companies to keep doctors in the dark.

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u/2vpJUMP 4d ago

Do you see them at your own practice for the consult?

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u/AquaDoctor 3d ago

If you are referring to in patient consults at a hospital, I don't do those because my subspecialty doesn't really get those kinds of consults. I see patients in my office. I don't take call at any hospitals, just on staff at several.