tracelogoRB Why do I pay an administrative fee to HNS?

 

 

 

 

HNS wants you to understand why you pay an "admin fee" to HNS.

 

The HNS Administrative Fee is not a charge for processing claims. HNS contracts with individual healthcare professionals, and with insurance and managed care companies who utilize our network as their preferred provider organization (PPO). Patients who have insurance with HNS contracted payors often choose to seek care from an "in-network" provider. The names of the "in-network" providers are listed on payor websites and in the PPO Provider Directories provided to members promoting steerage of new patients to our healthcare professionals.  HNS does not receive any compensation from the insurance companies and managed care organizations that contract with HNS. The HNS admin fee provides the network with revenue to fund the cost of the services and administrative functions we provide.

 

Some of these services include:

  • Network Development

  • Credentialing / Recredentialing

  • Contract Negotiation

  • Quality and Utilization Management

  • Clinical Resources and Support

  • Central Claims Administration (central processing of claims to the contracted payors and disbursement of monies back to each provider)

  • Continuing Education

  • Electronic Claims Filing (to improve efficiency and faster payments)

  • Administrative Support Services, including HNS Service Representatives (to assist in resolving claims and/or payment issues)

  • Electronic Funds Transfer

  • HIPAA ERA 835 Files (automated payment posting)

  • Educational Website

 

The HNS Admin Fee is calculated against the allowable amount on each member's EOB. Specifically, the admin fee is charged against the sum of the deductible amount, the co-payment/co-insurance amount, plus the amount paid by the health plan, for each service line on the EOB.

 

NOTE:  The "allowable amount" is the contracted rate that the payor intends for the provider to collect for the service provided that is represented by a particular CPT or HCPCS code.

 

Remember that all members' insurance plans have one or more of the following:

 

    • Co-payment

    • Co-insurance

    • Deductible

  

When the claim is adjudicated by the payor, the EOB and payment are sent to HNS, most often in a large bulk payment and EOB file. HNS then tracks and allocates all monies and EOBs received from each insurance company for each HNS Healthcare Professional, and provides the EOB and payment to each provider on the next scheduled HNS bulk provider payment date.

 

HNS does not take an admin fee when, per the EOB, the provider will not receive ANY payment for his services. HNS ONLY receives payment for services for which the provider will be paid (whether the amount is collected as a co-payment, deductible, co-insurance or from the insurance plan).

 

Banker's Rounding

 

In calculating the HNS Admin Fee, HNS utilizes Banker's (or Statistician's) Rounding.  In use by most banking and financial institutions, this type of rounding produces results that, on average, round numbers down as often as they are rounded up. In any large set of numeric data, there is a fairly equal distribution of even and odd numbers. Unlike conventional rounding, banker's rounding prevents data from being skewed upward and also prevents the data from being skewed downward. Banker's rounding is considered the most unbiased form of rounding.

 

HNS' software rounds based on the number in the 3rd decimal place.

 

In Banker's Rounding:

 

  • If the third decimal is 0-4, the amount is rounded DOWN.

  • If the third decimal is 6-9, the amount is rounded UP.

  • If the third decimal is 5, the amount is rounded to the nearest EVEN cent.

 

The HNS Admin Fee is applied to the "allowable" amount, and the allowable amount is calculated per service line on each EOB. Remember, the allowable is the sum of the amount paid by the payor and the amount owed by the patient (co-payments, co-insurance/deductible).

 

The total admin fees on a particular HNS Remittance Summary are the sum of the admin fees for all service lines on the EOBs associated with that remittance summary.

 

Examples of Banker's Rounding:

  • 7.644 would round to 7.64 (the third decimal is a 4, so number is rounded DOWN).

  • 7.647 would round to 7.65 (the third decimal is a 7, so number is rounded UP).

  • 7.645 would round to 7.64 (the third decimal is a 5 and the nearest EVEN cent would be 7.64, so number is rounded DOWN).

  • 7.635 would round to 7.64 (the third decimal is a 5 and the nearest EVEN cent would be 7.64, so number is rounded UP).