The out-of-network payment model is one that many ambulatory surgery centers rely on, and continues to be a viable option for ASCs in today's healthcare climate.
For most ASCs, out-of-network revenue at 20 percent of the ASC's total revenue would exceed the risk tolerance as a viable investment, states HealthCare Appraisers' 2014 ASC Valuation Survey.
The OON model offers surgery centers numerous benefits, according to a Becker's ASC Review article, including:
• Retaining all legal rights under federal and state laws to negotiate reimbursement on behalf of the patient
• Avoiding sub-par reimbursement or no reimbursement from insurance companies that have anti-assignment clauses
It is also important that surgery centers remember that diversifying claims is a key element of financial success, according to the article.
If done right, out-of-network billing can be extremely beneficial for your ASC, and if done wrong, the consequences can be devastating, notes Scott J. Rein, president, Strategic Outpatient Solutions in an Amerinet report.
The right approach to out-of-network billing involves careful analysis of existing contracts and payer mix and a willingness of physicians to drop or decline losing contracts, adds Mr. Rein.
Learn more about out-of-network reimbursement as well as strategies to increase it during a webinar hosted by Becker's ASC Review and MediGain on March 18 from 11:00 a.m. to 12:00 p.m. CST.