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Trends in commercial payer rates for ASCs

The 2019 ASC Valuation Survey by HealthCare Appraisers outlined statistics on out of network billing risk and potential changes coming to commercial payer rates.

HealthCare Appraisers and the Ambulatory Surgery Center Association collected data from 26 companies, including ASC management companies, investment bankers and business brokers to compile its report.

A quarter of respondents said an ASC with 1 percent to 10 percent of its revenue from out-of-network payers would exceed their risk tolerance. However, one-third had a higher tolerance for out-of-network reimbursement; 34 percent said 11 percent to 20 percent of revenue exceeds risk tolerance.

Respondents also weighed in on the changes they observe in commercial payer rates year-over-year. They observed the following changes:

● Decrease in rates: 4 percent
● 0 percent to 1 percent increase: 13 percent
● 1.1 percent to 2 percent increase: 36 percent
● 2.1 percent to 3.0 percent increase: 36 percent
● 3.1 to 4 percent increase: 11 percent

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