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Strategies for payer negotiations, high-deductible patients & more — 5 insights from a practice administrator

As the practice administrator for Exeter, N.H.-based Access Sports Medicine & Orthopaedics, Pamela Bronson was instrumental in the development and continued success of the Access Sports Medicine ASC and Northeast Surgery Center of Newington (N.H.). 

Ms. Bronson shared her thoughts on outpatient reimbursement trends with Becker's ASC Review.

Note: Responses were lightly edited for style and clarity.

Question: What are the biggest payer and reimbursement changes your practice has experienced over the past two to three years?

Pamela Bronson: [We've seen] higher deductibles and coinsurance. [Among patients, there's a] lower percent of uninsured, but [a] higher percent of underinsured. This is due to the shift in patient responsibility through higher deductibles, copays and stricter guidelines for covered services for elective procedures. [There are also] more payer-sponsored incentives offered directly to patients as an incentive to use lower-cost providers.

Q: Are you seeing more risk-based contracts or price transparency in your market?

PB: Yes. Payers are creating more user-friendly databases for patients to find lower-cost providers.

Q: What is your strategy for working with patients who have high-deductible health plans?

PB: [We use] credit-card-on-file systems for balances due [and] more deposit collection efforts for expensive elective procedures or cost of goods sold like durable medical equipment.

Q: How do you approach payer negotiations?

PB: We position ourselves as a high-quality, lower-cost provider for their network to create value that should be rewarded in higher reimbursement than standard rates.

Q: What's your best advice for ensuring payer negotiations are successful?

PB: Data, data, data — on both price and quality.

To participate in future Becker's Q&As, contact Angie Stewart at astewart@beckershealthcare.com.

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