The contracted rate isn’t the whole story. Two ASC administrators said payer talks this year came down to fine print, implant costs and case-level cost data.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What’s changed most in your payer negotiations or reimbursement over the past year?
Kim Fullone, RN. Administrator of Ambulatory Surgery Center of Niagara (Niagara Falls, N.Y.): One of the biggest changes for us this year was partnering with a billing company that has been excellent at payer contract negotiations. They know how to dig into the fine print and identify terms I might not have caught on my own. We’re looking beyond the headline reimbursement rate to understand what we’ll actually be paid, especially for cases with costly implants and supplies. We’ve also been pushing for implants to be reimbursed at invoice cost.
Ed Tolentino. Administrator of Outpatient Surgery Center of Central Florida (Wildwood): The biggest change has been the need to understand reimbursement at a much more granular level. As we add higher-acuity cardiovascular and EP procedures, we’re looking beyond the contracted rate and focusing more on the actual economics of each case — reimbursement, supply cost, staffing and procedure time. Payers are also becoming more demanding on authorization, so having good data and a clear understanding of our cost per case has become much more important in those conversations.
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.
