5 strategies for ASCs to overcome common payer stumbling blocks

Mary Rechtoris - Print  |

Although more payers are becoming aware of the many benefits ambulatory surgery centers provide, many centers find getting contracts and viable rates to be a challenge.

SusaSusan Cheek 1n Cheek, CPA, CHCC, CASC, administrator of Dallas Endoscopy Center and CEO of BridgeConx software solutions, understands the obstacles many surgery centers face when dealing with payers and lays out key strategies for overcoming common stumbling blocks.

"If you have previously been out-of-network with a payer and you want to be in-network, that is a huge challenge," says Ms. Cheek. "Even if you are in-network, many ASCs are having trouble getting sustainable rates."

Here are five strategies:

1. Stay in contact with your representative. Some contracts will outline how often ASCs can seek rate increases. Many payers are changing a center's representative frequently, posing a challenge for ASCs to strengthen those relationships. Similarly, some payers are forgoing representatives, forcing administrators to call in and speak to someone with whom they're unacquainted; this lack of relationship often will not help increase their rates. Thus, those ASCs with a representative should regularly contact him or her as their contract allows, so they can build upon the human element of the relationship. Consider inviting representatives to your center, so they can understand all ASCs have to offer.

"It is a newer phenomenon where some payers are not assigning representatives so you become just a number," Ms. Cheek says. "It is important to stay in touch with your payers and know who your representative is."

2. Invite representatives to attend state society meetings. As vice president of the Texas Ambulatory Surgery Center Society, Ms. Cheek has firsthand experience with representatives attending meetings and learning the ASC industry's ins-and-outs.

"You get a chance to have more face time with the representative," she says. "They get more of a chance to learn about your surgery center and the quality. You get to build a relationship, and they begin to trust you."

3. Increase your case volume. ASCs with smaller case volumes often have trouble negotiating good rates with payers. Ms. Cheek explains if ASCs can't get a contract with a payer, they will lose that patient to a hospital or another facility that is in-network, as it is less costly for the patient. Dallas Endoscopy Center is a single-specialty ASC with a high volume of cases, which allows the ASC to establish good contracts with payers. The larger the footprint, the more likely an ASC is to obtain better rates.

4. Be on the lookout for insurance companies' credit card payments. ASCs can lose a substantial amount of money when accepting insurance companies' credit card payments because they will process through an ASC's credit card payment system. The center will then have to pay the credit card processing fees, taking away from the ASC's overall reimbursement.

To avoid losing capital, Dallas Endoscopy Center asks payers to reprocess the payment to them when the payer submits credit card payments. In their payer contracts, Dallas Endoscopy Center ensures the insurer can submit payments electronically to the center's bank account and does not have the right to pay the center with a credit card. Ms. Cheek advises ASCs to monitor these payments carefully.

5. Scrutinize your payer contract. Similarly, payers may often put other language in a contract that takes money away from a center. Ms. Cheek explained some payers will put in language stating an ASC cannot collect payments from a patient until after the center receives the explanation of benefits.

"It is important to collect the money upfront," she says. "Collecting upfront and verifying benefits are standard practices. It is harder to collect the money after people have the procedures. If someone eats a loaf of bread, they won't want to pay for it later."

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