How to Determine ASC Usual and Customary Rates for Out-of-Network Procedures: Q&A With Ken Bulow of GENASCIS

Ken Bulow is COO of GENASCIS.
 
Q: How do ambulatory surgery centers come up with usual and customary fees to bill insurance companies for out-of-network procedures?

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Ken Bulow: We typically use one of the following methods:

 

  • Medicare times X percent where X can be 10-15 times Medicare.
  • Some percentage of the Ingenix rate for that area.
  • We will also use our proprietary MEDIBIS database to determine current prevailing market rates in the area.

 

Learn more about GENASCIS.

 

Read more from GENASCIS:

 

4 Best Practices to Control Labor and Supplies for Surgery Center Cases

 

4 Steps to Improve Collections Through Contractual Write-Offs

 

6 Steps to Improve Collection of Time of Service Patient Co-Pays

At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.

Register to Attend Webinar

Is ambulatory care healthcare’s big margin engine? 4 leaders weigh in

Wednesday, July 29
1:00 PM - 2:00 PM CDT

Presenters: Joe Ganley, athenahealthJeffrey Flynn, CASC, Gramercy Surgery CenterBryan Tsao, Access Center, Loma Linda University HealthJason Zepeda, Northridge Hospital Medical Center, CommonSpirit HealthGreg DeConciliis, PA-C, CASC, Boston Out­Patient Surgical Suites

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