7 Guidelines for Better Payor Contracts

Caryl A. Serbin, RN, BSN, LHRM, president and founder of Serbin Surgery Center Billing, suggests following these seven guidelines to improve your payor contracts.

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1. Ensure your contract rates cover case cost plus profit margin
2. Be sure that contract pays for multiple procedures
3. Ensure that implant rates cover cost plus shipping and handling
4. Be aware that Medicare implant reimbursement does not always cover cost
5. To ensure you are being paid accurately, load and maintain up-to-date contracts in your software. Include:

  • Rates by CPT
  • Discount on multiple procedures
  • Implant allowance

6. Provide personnel with current insurance matrix
7. Maintain implant fee matrix

Learn more about Serbin Surgery Center Billing.

Read more insight from Caryl Serbin:

6 Areas of Focus for Collecting Full Payment: Critical Steps to Take Prior to Billing (Part 1)

5 Steps to Finding the Right ASC Reimbursement Cycle Employees

Guidelines to Assign ASC Reimbursement Cycle Responsibilities to Staff Members

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.

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Tuesday, August 11
12:00 PM - 1:00 PM CDT

Presenter: Gautam Shah, MBA, FACHDM, NextGen Healthcare

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