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Payer Contracting and Other Issues for ASCs

Payer Contracting and Other Issues for ASCs

On Friday, October 25, 2019, National Medical Billing Services Vice President of Managed Care Contracting, Scott Allen was a participant in the “Payer Contracting and Other Issues for ASCs” panel at Becker’s ASC 26th Annual Meeting: The Business and Operations of ASCs. The other panelists included: Lisa Davis, Administrator, The Center for Minimally Invasive Surgery; Allison Stock, RN, JD, CASC, Executive Director, Great Lakes Surgical Center; Heather Hilgendorf-Cooley, MBA, CASC, Administrator, Spring Park Surgery Center, LLC.

Key Takeaways

• Have completed managed care contracts and know/understand them. Know your fee schedules and payer contracts. Have the whole contract – amendments, crosswalks, etc. – and make sure they are in a place the billing department can access.

• Denied claims. What are some of the processes and tools ASCs can use to reduce the number of denied claims? The biggest thing is for the front desk to understand if the payer is fully funded or self-funded. Make sure the billing department understands your contracts. Check eligibility. Make sure whoever is verifying the insurance coverage knows exactly what they are verifying and if an authorization is needed.

• Payer relationships. Develop that point of contact. We can tout quality measures all day long but inviting them to visit your surgery center to see for themselves.

• Be as specific as possible. Look at a 90-day out clause. Look at an evergreen clause. Look at specific payer language in terms of unlisted codes. Your 3-page contract may expand into a 10-page contract – but you will have most things covered.

• Look for opportunities. So many things are changing in healthcare right now. Be willing to change – consider changing/adding specialties. You must be willing to change. You can not longer say, “We’ve done it this way for the past 15 years and we’re going to continue this way.”


This post was first published October 25, 2019 and was updated July 29, 2020.

Nader Samii, Lisa Rock, National Medical Billing Services, Becker's ASC Review

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