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Not Planning for a Potential Year-End OON Situation? You Should Be

In mid-March 2020, we wrote about navigating a potential non-par situation as COVID-19 was taking hold. There was so much unknown at the time, and we recommended dealing with some of that uncertainty by clearly communicating to patients about what to expect in a non-par situation. Almost half a year (can you believe it?) later, we are a little wiser to the impacts of COVID-19. Our original point still stands: Providers must be prepared to communicate about an OON situation as part of their negotiation communications strategy. And for providers facing year-end contract termination dates, planning for that situation needs to be happening now.

While 12/31/20 may feel like a long time away, there is a lot that can and will happen between now and then, resulting in unpredictable burdens on health system operations. And if you think that payors will be hesitant to take providers OON during an ongoing public health emergency — think again. In the last six months, we’ve seen payors act as aggressively as ever, holding out until the last minute or even keeping a provider out-of-network for months. Don’t delay hard conversations internally about a potential non-par scenario until the decision has been made to go OON. Who knows what issues your health system will be facing when that time comes. Get ahead of it now and maximize your chances for a smooth transition.

Here are the types of questions we’re helping our clients answer early:

  • Who are the key internal stakeholders who can help us quickly and efficiently make decisions about a non-par situation?
  • What is our scheduling strategy given our OON date, and how might that strategy be impacted by COVID-19?
  • Are we clear on the payor’s Continuity of Care benefits, and how patient-facing colleagues will communicate that information to patients?
  • In a non-par scenario, how will we approach collection of patient obligations? What billing and claims policies need to be updated if we are non-par?
  • Is there an opportunity to take advantage of Open Enrollment to educate patients about protecting their in-network access in the 2021 benefit year?

 

August 13, 2020
Nothing beats a good old-fashioned conversation.
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