Editor’s Note: this blog post originally appeared on ECG Management Consultants’ website.
It’s more important than ever to read an ASC contract or amendment prior to signing it and again after receiving the finalized version. We recommend highlighting key contract payment terms and language provisions that impact reimbursement for your business office so it may operationalize the contractual obligations and build them into policies and procedures to maximize contract rates and avoid lost revenue.
Juggling the time frames and rules of contracts can be difficult because they may vary greatly from plan to plan and even between products within the same health plan. You should establish a contract methodology tracking mechanism so your staff can keep your ASC business office compliant with the rules and update the claims system appropriately per payor and the various products in each contract. This can also help you and your staff identify trends and issues with various payors.
Below are 10 important managed care contract considerations that you should review with your ASC business office. Create clear policies and assign responsibilities for each so that your business office realizes the value of the ASC’s contracts and collects 100% of the reimbursement that is due from all payors.
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