At the 20th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 24, Kelly Webb, vice president and general manager of MediGain's ASC billing division, spoke about challenges ASCs are facing in reimbursement.
Much of the challenge facing ASCs stems from the newly insured, whether an ASC is in network out out-of-network. All centers need to tighten their approach to billing and collections, and exercise caution about reimbursement from the healthcare reform law's insurance exchanges.
"If you fill your ASC with exchange patients, the ASC may go broke," said Mr. Webb. "There are a lot of sicker patients being dumped by insurance companies. That patient then has to go to the exchange at a lower case rate."
Higher premiums and deductibles are also cramping ASCs' cash flow, as it may be more difficult to obtain money in a timely manner from patients. Mr. Webb said some premiums are going up 150 percent and deductibles have climbed by $5,000 to $10,000.
"You're going to have to stark asking for money upfront," said Mr. Webb. "Many already do that, but you'll have to tighten it up," he said. ASCs can make financial coordinators available to patients to help explain benefits and procedure finances. The front desk can also ask for a portion of the total payment before the procedure is scheduled.
"Teach and involve patients to help get paid," said Mr. Webb. "Providers need to understand they do not hold the power with medical claims or reimbursements. The patient has the contract and has all the rights for payment. If you involve your patients more, you can get more payments."
Mr. Webb also pointed out how ASCs can benefit from the newly insured under the healthcare reform law. "When 70 million new patients sign up, where do they go for service? The hospital," said Mr. Webb. "When overcrowded, where will the others go for medical services? I think it should be the ASC market." He said ASC patients have a physician from start to finish, a registered nurse on site and medical care with lower infection rates.
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Much of the challenge facing ASCs stems from the newly insured, whether an ASC is in network out out-of-network. All centers need to tighten their approach to billing and collections, and exercise caution about reimbursement from the healthcare reform law's insurance exchanges.
"If you fill your ASC with exchange patients, the ASC may go broke," said Mr. Webb. "There are a lot of sicker patients being dumped by insurance companies. That patient then has to go to the exchange at a lower case rate."
Higher premiums and deductibles are also cramping ASCs' cash flow, as it may be more difficult to obtain money in a timely manner from patients. Mr. Webb said some premiums are going up 150 percent and deductibles have climbed by $5,000 to $10,000.
"You're going to have to stark asking for money upfront," said Mr. Webb. "Many already do that, but you'll have to tighten it up," he said. ASCs can make financial coordinators available to patients to help explain benefits and procedure finances. The front desk can also ask for a portion of the total payment before the procedure is scheduled.
"Teach and involve patients to help get paid," said Mr. Webb. "Providers need to understand they do not hold the power with medical claims or reimbursements. The patient has the contract and has all the rights for payment. If you involve your patients more, you can get more payments."
Mr. Webb also pointed out how ASCs can benefit from the newly insured under the healthcare reform law. "When 70 million new patients sign up, where do they go for service? The hospital," said Mr. Webb. "When overcrowded, where will the others go for medical services? I think it should be the ASC market." He said ASC patients have a physician from start to finish, a registered nurse on site and medical care with lower infection rates.
More Articles on ASC Reimbursement:
ASC Reimbursement Trends as a Percentage of HOPD12 Steps to More Robust Reimbursement in a Surgery Center
3 Myths of Out-of-Network Reimbursement