“There aren’t a lot of opportunities to increase [ASCs’] reimbursements,” CollectRx CEO John Bartos said at the Becker’s ASC Review 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago. “Your in-network contracts are what they are — there’s very little opportunity to increase those rates. Medicare and Medicaid is what it is. Out-of-network represents the last great opportunity for many providers to increase their reimbursement on out-of-network bills.”
Other key reasons for going out-of-network, according to Mr. Bartos, are:
• Patients are increasingly demanding choice from their providers
• Every year, $60 billion in claims are paid out-of-network
• PPO enrollment will continue to grow
The decision to go out-of-network can be a tricky one for any healthcare facility. While the rewards are great — OON reimbursement tends to almost double the in-network rates — so are the risks. However, ambulatory surgery centers looking to go out-of-network need to keep abreast of legal and market developments.
In a CollectRx-sponsored webinar, Mr. Bartos will discuss a number of these developments, such as the impact of recent court cases and legislation on out-of-network coverage and how payers are using silent PPOs to decrease reimbursements.
Register for the webinar here.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
