in network vs out of network insurance
AMS Solutions

Frequently Asked Questions

Outsourcing your medical billing to a third party who specializes in billing is beneficial for a number of reasons beyond saving you time and money.  Having a team of professionals at your disposal ensuring that the entire process from start to finish is done correctly is the most important thing you can do to protect your revenue cycle.  Professionals like us, stay on top of the current complexities surrounding medical billing leaving you more time to operate your business.

Streamlined Process

Having an uninterrupted flow of professional billing services is an extremely important piece to the overall efficiency of your business.  When poor billing practices start to define your business it will likely lead to the loss of patients/ clients as well as not allow your business to plan accordingly for your recurring overhead.  Both of which can be catastrophic for a healthcare provider of any kind.  The focus of a business owner in the healthcare industry should always be providing top notch patient care rather than worrying about when claims are being submitted and when you need to begin following up.

Revenue Enhancement

While you might initially think it is more cost effective to handle all of your billing in house, this very rarely ends up being the case.  The main reason for this is that typically when billing is handled by anyone other than professionals mistakes are bound to regularly occur.  A simple typo or wrong code can throw off your entire revenue cycle.  In addition, timely submission of claims and utilizing the best practices will always lead to higher reimbursement rates.

Credentialing Process

The Affordable Care Act has substantially increased physician credentialing requirements for Medicare and Medicaid enrollment to reduce fraud and abuse. Now physician credentialing is required by the federal government, each state government, and each accreditation agency. Taking care of the hard work of insurance credentialing can be a laborious and lengthy process.  If your staff isn’t up to the challenge or has limited experience, why not take advantage of a third-party medical billing firm, and outsource this work? AMS-Solutions is capable of providing what kind of details your staff will need to provide for verification as it negotiates this complicated task.

AMS Solutions is a Full Revenue Cycle Management company. We create a custom plan to help you from the charge entry process, to claim submission, to AR Management (working denials/rejections) and posting the payments. We also provide a review of your fee schedule during the onboarding process. It doesn’t matter how ugly or convoluted your aging A/R becomes, we provide an aging A/R service for all new partners. We can also provide you with an audit of your claims over the last 90 days. Our credentialing team can help you with all the billing aspects of setting up your new practice, adding on new providers, and walking you through the credentialing process to receive payments from new payers. 

At AMS Solutions, we pride ourselves in being the most communicative and transparent billing company available. We will provide you with custom reporting showing in-depth reporting and helping give clarity to the financials within your practice. Too often a provider will begin their practice without having a full understanding the financial side of their business. We are here to not only provide that information but also talk you through what it means and help give you the tools and knowledge to grow your practice. 

At AMS Solutions we are not trying to be a mere outsourced service. We understand that every practice is different, having it’s own unique needs and ways of operating. Over the last 30+ years we have focused on becoming partners with our customers and leaning into long term growth focused relationships. We set each partner up with a specific account manager and success team promising fluid and quick communication with them throughout the entirety of the partnership. At AMS Solutions we are 100% US employed guaranteeing customer service that is unrivaled. We are flexible and able to work within your current billing software or provide you with top-of-the-line EHR and Billing Software through AdvancedMD. We only employ the best of the best and therefore, we provide the best service in the industry. With over 200 years of collective billing experience in our office, we have the expertise to increase your net revenue and help you grow financially.

At AMS Solutions, we also help you (Physicians/providers) get credentialled, i.e., enroll and attest with the Payer’s network and be authorized to provide services to patients who are members of the Payer’s plans. The credentialing process validates that a physician meets standards for delivering clinical care, wherein the Payer verifies the physician’s education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training. 

Payers may delay or refuse payments to physicians who are not credentialed and enrolled with them. These impact the financials of the practice negatively.

The first step would be to determine which payers network you wish to join.  Assess the payer mix of your patient population to determine which payers are most common amongst your patients.  Once you have determined which networks you would like to join you will need to submit an application.  
Once an application is received you will likely need to follow up a number of times to receive a timely response.  This process typically takes about 6 months, constant follow up may shorten this process.  
Once you have received an offer with terms and rates it is important to reference that against your cost of services.  Verify all contract terms and ensure that your clinic or lab and finance department can meet the contract terms. Above and beyond the fee schedule, consider infection control, licensing, quality assurance, site visit, and any other requirements that are stated within the contract. Violating the stated requirements can be grounds for lost reimbursement or contract termination.
Now it’s time to negotiate any objectionable conditions.  Check the contract for paragraphs that can restrict your ability to collect reimbursement. It is not uncommon for third-party payer contracts to include language that requires billing for reimbursement within 60 days post service and/or to have restrictions for corrected claims reimbursement.  Read the entire agreement from the third-party payer and ensure that it includes a description of covered services as well as a current fee schedule. Ideally, the fee schedule should include the procedure codes for all of the services you provide, but it must include the procedure codes and expected reimbursement for all of the covered services. If a fee schedule is not included within the contract or was not otherwise shared with you, request a fee schedule from the payer before you sign the contract.  It is also important to reference your out of network rates when negotiating the in-network rate.  The goal is for you to provide their members with more access while making your life and decreasing the financial responsibility of the payer.  
Once you have agreed to terms, sign the contract and keep a copy on file for purposes of renewal and annual updating of fees.

The arena of medical billing software is ever changing and growing. We at AMS Solutions understand to provide exceptional service, we must also continually expand our knowledge of different software systems. We provide a custom plan for your practice no matter what software you are utilizing. If you are looking for which software will best fit your needs or you are looking at switching software systems,  we can help  give you direction due to our expansive knowledge of EHR and medical billing software systems. We can also provide you with an EHR and Billing Software as a part of your service. Ask us how…

AMS Solutions is a preferred partner with AdvancedMD and eClinicalWorks, providing an easy transition to our full revenue cycle management if you are utilizing either of these systems currently.

Below is a list of medical software solutions that we are currently knowledgeable in. Because it is an ever-growing industry, we are continually training our billers on new software systems. If you don’t see your software system below, let us know and we can learn your software to apply our expertise revenue cycle management to be the best solution for you.


A participating health care provider (in-network) claims must be submitted within 90 days of the date of service. 
An out-of-network provider must submit claims within 180 days of the date of service.
It is always recommended to submit claims as close to the dates of service as possible to ensure timely payment and to avoid disruption in the revenue cycle.
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