When running a medical practice, one of the most important decisions you’ll make is whether to become a Participating (PAR) provider or remain a Non-Participating (Non-PAR) provider. This choice not only impacts how you get paid but also affects the experience your patients have when using their insurance.
Understanding the difference between these two options can help you make the best decision for your practice, ensuring that you balance financial health with patient satisfaction.
What Are PAR Providers?
A Participating (PAR) provider is a healthcare professional who has signed an agreement with insurance companies, accepting their reimbursement rates as full payment for services rendered.
This means that PAR providers must follow the insurance company’s fee schedules, which usually translates to lower out-of-pocket costs for patients.
However, it also means that the provider may not always receive the full value of the services they provide due to the discounts agreed upon with insurance companies.
How It Works for Patients:
Patients who visit a PAR provider will generally pay less for services, as the provider bills their insurance directly and only collects any co-pays, deductibles, or coinsurance from the patient. This can make PAR providers more attractive to patients, as their total healthcare costs are typically lower.
Benefits for PAR Providers:
- Increased Patient Volume: Being listed as an in-network provider on insurance panels can bring more patients to your practice, as many patients prefer to visit doctors whose services are covered by their insurance.
- Faster Payment Cycles: Claims from PAR providers are often processed faster by insurance companies, leading to quicker reimbursements.
- Fewer Collection Issues: Since the majority of the payment comes directly from the insurance company, providers often face fewer issues with collecting payments from patients.
However, there are trade-offs to becoming a PAR provider. Providers often face lower reimbursement rates, as they are bound by the insurance company’s negotiated rates. Additionally, dealing with insurance companies can mean increased administrative work and paperwork, which can eat into your practice’s efficiency.
What Are Non-PAR Providers?
Non-Participating (Non-PAR) providers, on the other hand, have not signed contracts with insurance companies. This gives them more freedom to set their own fees for services rendered.
Patients who choose to see a Non-PAR provider may have higher out-of-pocket costs because insurance companies typically reimburse a smaller portion of the provider’s bill, and patients are responsible for paying the balance.
How It Works for Patients:
Patients who visit a Non-PAR provider can still submit claims to their insurance companies, but the reimbursement rates are typically lower. In some cases, patients may have to pay the full cost upfront and then seek reimbursement from their insurance company afterward.
This often makes Non-PAR providers less appealing to patients who rely heavily on their insurance to cover medical costs.
Benefits for Non-PAR Providers:
- Freedom in Pricing: Non-PAR providers can set their own rates for services without being limited by the insurance company’s fee schedules. This allows them to charge what they believe their services are truly worth.
- Less Administrative Burden: Non-PAR providers may have less paperwork and administrative work related to insurance claims, as they are not bound by insurance company rules.
- Potential for Higher Income: With fewer restrictions on how much they can charge, Non-PAR providers have the potential to earn more per patient than PAR providers, particularly if they serve a patient base that can afford higher out-of-pocket costs.
While Non-PAR providers enjoy greater freedom, the lack of an insurance contract may deter patients, especially those who rely on their insurance plans to manage healthcare costs.
It’s also important to note that Non-PAR providers might face more challenges in collecting payments from patients since they often deal directly with patients rather than receiving payments through insurance.
PAR vs Non-PAR Providers: Key Differences
Now that we understand what it means to be a PAR or Non-PAR provider, let’s take a closer look at the key differences between these two options. While both types of providers offer important services to patients, they operate in different ways when it comes to insurance coverage, payment structures, and patient experience.
1. Reimbursement Rates
- PAR Providers: Accept the insurance company’s negotiated rates as full payment for their services. This usually results in lower costs for the patient but can lead to lower reimbursements for the provider.
- Non-PAR Providers: Set their own rates and are not bound by the insurance company’s fee schedule. This can result in higher earnings for the provider, but patients may need to pay more out-of-pocket.
2. Payment Process
- PAR Providers: Bill the insurance company directly and are paid according to the agreement. Patients are only responsible for any co-pays, deductibles, or coinsurance.
- Non-PAR Providers: Typically require the patient to pay upfront and then file for partial reimbursement from their insurance. This can increase the financial burden on the patient, which may affect their willingness to seek care.
3. Patient Attraction
- PAR Providers: Attract more patients who are seeking lower out-of-pocket costs, as they are listed as “in-network” providers with insurance companies.
- Non-PAR Providers: May attract fewer patients, especially those who rely on insurance coverage, as they are considered “out-of-network.” However, Non-PAR providers often attract patients looking for specialized or premium services that may not be available from PAR providers.
4. Administrative Responsibilities
- PAR Providers: Deal with more administrative work, as they must comply with insurance company rules, file claims, and follow specific guidelines for documentation and reimbursement.
- Non-PAR Providers: Experience less administrative burden related to insurance claims, as they work directly with patients and are not required to follow the same protocols set by insurance companies.
Advantages of Being a PAR Provider
For many medical practices, the decision to become a PAR provider offers numerous benefits. One of the most significant advantages is the ability to attract a larger patient base. Since most patients prefer to visit providers who are in-network with their insurance, being a PAR provider makes your services more accessible.
Additionally, the process of getting paid is often quicker and more predictable, as insurance companies typically process claims faster for PAR providers.
Another important benefit is the reduced financial burden on patients. By accepting the insurance company’s negotiated rates, PAR providers can offer lower out-of-pocket costs to their patients, leading to better patient satisfaction and retention.
This can be especially beneficial for practices that serve a large number of patients who rely on insurance to cover their healthcare expenses.
However, becoming a PAR provider does come with some challenges, particularly when it comes to reimbursement rates. Since PAR providers agree to accept the insurance company’s rates as full payment, they may be paid less than what they would receive if they were able to set their own fees.
Why Some Providers Choose to Be Non-PAR?
Despite the potential benefits of being a PAR provider, some healthcare professionals prefer to remain Non-PAR. One of the primary reasons for this choice is the greater flexibility it offers.
Non-PAR providers are not restricted by insurance company fee schedules, which means they can charge what they believe is fair for their services. This freedom in pricing can be particularly appealing to specialists who offer high-demand or niche services that patients are willing to pay more for.
Another advantage of being a Non-PAR provider is the reduced administrative burden. Without the need to follow the insurance company’s strict rules and documentation requirements, Non-PAR providers can focus more on patient care and less on paperwork. This can lead to a more streamlined practice and greater satisfaction for both the provider and their staff.
However, Non-PAR providers may face challenges in attracting and retaining patients, particularly those who cannot afford the higher out-of-pocket costs. Additionally, the process of collecting payments can be more complicated, as patients may be required to pay upfront and seek reimbursement from their insurance company afterward.
Which Option Is Better for Your Practice?
Deciding whether to become a PAR or non-PAR provider depends on several factors, including your practice’s financial goals, patient demographics, and administrative capabilities. Here are a few questions to consider when making this decision:
What type of patients do you want to attract? If your patient base relies heavily on insurance to cover medical costs, becoming a PAR provider may be the better option. On the other hand, if your practice serves a more affluent demographic or specializes in services that are not typically covered by insurance, non-PAR status could be more beneficial.
How important is cash flow to your practice? PAR providers typically receive faster payments from insurance companies, which can help with cash flow. Non-PAR providers may experience more delays in payment, especially if they rely on patients to submit claims and seek reimbursement.
How much administrative work are you willing to take on? PAR providers often have to deal with more paperwork and comply with insurance company rules. If you prefer to have less administrative work, becoming a Non-PAR provider may be a better fit.
Ultimately, there is no one-size-fits-all answer when it comes to choosing between PAR and Non-PAR provider status. The right choice for your practice will depend on your unique goals and the needs of your patients.
Conclusion
Understanding the difference between PAR and Non-PAR providers is essential for any healthcare practice. Both options offer unique benefits and challenges, and the decision you make can significantly impact your practice’s financial success and patient satisfaction. Whether you choose to become a PAR provider to attract more patients or opt for Non-PAR status to maintain control over your pricing, it’s crucial to weigh the pros and cons carefully.