对于大多数asc, the upheaval caused by COVID-19 has left little time for reviewing managed care contracts and renegotiating with payers. But your ASC has likely undergone changes since March 2020, and payer contracts negotiated prior to the pandemic may not address case mix shifts and new trends.
现在病例量可能正在恢复正常, it’s time to see where there may be room to optimize payer reimbursement. Below are eight ways to ensure ASC payer contracts stay current and maximize revenue through this difficult time and going forward.
1. 确认管理式医疗合同续约日期
Typically, contracts will remain in effect past the initial term or after the last annual increase. 不要求年度加薪可能代价高昂. If you don’t ask for an increase when a contract’s term is up, the health plan will usually continue to pay the same rates.
2. 检查病例混合班次
以尽量减少COVID-19的暴露, patients increasingly are opting to have their outpatient elective surgeries conducted at ASCs instead of hospitals. 过去一年, we have seen a surge in spine and total joint cases migrating from hospital settings to ASCs. 另外, higher-acuity case volume has grown across all specialties, so be sure contracts are appropriately reimbursing for these cases and payers are allowing and preapproving them in the ASC setting, 特别是对于那些医疗保险认为只有住院病人.
3. 审核索赔数据
By comparing your current claims data to numbers from before the pandemic, you can project cost savings for both the ASC and payers.
- 如果有新的病例,他们是从哪里迁移过来的? Did the cases move from a higher-cost site of service for the payer? 如果是这样的话, quantify the cost savings for the payer over the course of a year for all cases so you can demonstrate this number during negotiations if necessary.
- Do you have new surgeons or specialists performing cases at the ASC? Are there any services your surgeons would like to bring to the ASC from the hospital setting? You can provide the anticipated cost savings to the payer by projecting the case volume for potential services that can migrate from the hospital to the ASC setting.
4. 包括外科云顶集团40011官网
Before you contact the payers, confirm case volume and cost data by talking to the ASC surgeons. Review this data with your surgeons and find out about any additional changes they are planning to their case mix and case volume at the ASC. Discuss the current trends and what is on the horizon for 2021 and beyond.
5. 确定新云顶集团的案例成本
纳税人 may want to know the costs involved in the new cases; be prepared to answer the following questions:
- Do any of the new cases include high-cost implant, such as total joints?
- Can you provide a sample of implant invoices for high-cost cases?
- 如果付款人将植入物包括在费率内, provide the highest-cost invoices to ensure reimbursement covers the highest-cost scenario..
- If these cases are not yet being performed at the ASC, are there quotes from the implant vendor?
6. 种植体报销分析
Determine whether your current contracts have reimbursement provisions and payment for high-cost 植入物. 植入物是否包括在手术病例中, or will the payer reimburse the cost in addition to the procedure? If implant costs are included in the carve-out rate or case payment, 确定完成该案例的总成本, 包括供应品, 植入物, 及其他营运费用.
7. 评估付款人收费表
In some contracts, the payer fee schedule rates for certain specialties may need to be increased. Review the reimbursement for high-volume cases to see if increases are needed to improve your bottom line, accounting for annual growth to the cost of doing business, including any additional costs associated with COVID-19 protocols and PPE. 也, 合并总营业费用, 包括薪金及福利, 作为每个案件总费用的一部分.
8. 包括商务办公室人员
Your office staff are probably well acquainted with your payers’ reimbursement processes. Prior to renegotiating, ask them to document and summarize any payer issues that you can address. Are there issues or delays with large claims or implant reimbursements? Office staff can confirm whether the payers are reimbursing claims according to the payment time frames as required in your agreements. 如果不是的话, your contract (or state prompt payment laws) may stipulate that you are due interest payments. Be sure to check the addendum language in your agreement for state regulations on interest payments.
Reviewing your data can lead to identifying improvements to your managed care contracts, 使你现在的收益最大化. It is valuable to update payer contracts before expanding services at your ASC.
Surgery migration to outpatient settings will continue.
你们医院有ASC计划吗?
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