In-Network vs Out-of-Network

So, what is the difference between being an in-network provider versus an out-of-network provider and why is that important to your patient. Well, basically if you are an in-network provider, you have signed a contract, you’ve been credentialed with a specific health care plan, such as Blue Cross Blue Shield. Why is this important to your patient? Well, by being an in-network provider, you are able to bill that particular insurance company, therefore, reducing the out of pocket expense to your patient.

So, out-of-network, basically we are not credentialled and that will increase the out of pocket expense to your patient. 

Next, we have our federal agency that runs our Medicare and Medicaid services and that’s CMS or our Center for Medicare and Medicaid Services. I highly recommend that you go to the CMS.gov website and familiarize yourself with it as it can be a very beneficial resource and tool when it comes to Medicare and Medicaid. 

We also have HIPAA, which is our Health Insurance Probability and Accountability Act and, in a nutshell, HIPAA sets the rules and guidelines for protecting our patients' information within our electronic health records as well as even our physical paper records we have within our office.  very very important that you and all of your team is trained and signed off on certification for HIPAA and how it relates to the privacy of your patient’s information.