1. Surgery center unable to contract with health plan. In some markets, health plans may simply refuse to contract with your ASC. “If the health plan feels they have an adequate network for their beneficiaries, they simply close the network,” Mr. Woollen says. “In these instances, out-of-network will be your only option.”
2. Health plan’s reimbursement rates are unsustainable. “When you have a firm understanding of your market, payor mix and case costs, you may determine that the in-network rates are simply too low,” Mr. Woollen says. “If you went in-network, you’d be losing money every time you performed a case with that particular payor.” If the incremental volume doesn’t provide the necessary returns to justify the discounts or revenues, out-of-network again may be your only option.
Learn more about Practice Partners in Healthcare.
Read more from the leadership of Practice Partners in Healthcare:
– 6 Steps for Making Money on a Convenience ASC
– 4 Kinds of Physicians Who Have Not Yet Invested in an ASC
– 5 Ways to Incent Good Behavior With Staff Bonuses
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.
