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MNRP Maximum Non-Network Reimbursement Plan

MNRP was primarily used for “Retiree Plans” as a way of lowering the out of pocket costs for Retiree’s or Medicare age members much like Medicare does, and the “New Non-Network Reimbursement Program" was Announced.

I believe this is one of the guides for the methodology for payment for ASC’s, Surgeons and physicians that were out of network.

The program effects payment for out of network claims for “Hospitals (inpatient and outpatient), no its or because it doesn’t always apply to both… Free-standing ambulatory surgery centers, Free-standing radiology centers, [and] Free-standing laboratories.”  United Healthcare included in the announcement “It is our hope that the implementation of this program will encourage more out of network providers to join our network”. 

MNRP is also disguised by the words “Webstrat” or “Berges” that all use the same system of 110% to 140% of Medicare allowed amounts based on the location of where the services were rendered.

Pricing and new “names” for methodologies continue to grow and reimbursement has continued to drop and at a declining rate for at least the last two years.

Most carriers base payment for out of network claims for commercial plans by:

1. Looking at the percentage of Medicare fee schedule
2. Determining if the ASC is contracted
3. Using a fee schedule developed by the carrier
4. 50% of the billed charges or allowable amount based on the demographic area.

According to some carriers, MNRP creates a maximum allowable reimbursement for out-of-network services using rates and methodologies established by Medicare.

The calculation for this “methodology” is typically the Centers for Medicare and Medicaid Service (CMS) Rates multiplied by factors.  These in my opinion are improper methods for determining UCR for out-of-network claims...

7 Things to look for in a Medical Billing Company

Medical billing is a very important part of a practice. We are not here to tell you that anyone can do it. All ASC’s, surgeons, and physicians must choose this person or company carefully because your practice depends on it.

FACT: A Medical Billing company can make or break an offices income.

Before you can choose a billing person you need to decide what your needs are. Do you prefer to outsource or have an in office Medical Biller?   If you have never outsourced your medical billing then consider speaking to other physicians and ask about their experiences.

7 Things to look for in a Medical Billing Company

1. Ask about how they work to streamline the billing process with other physicians and how the coding works...