Securing successful contracts with payers is becoming increasingly important for ASCs as they move toward negotiating value-based contracts.
Lisa Davis, administrator at The Center for Minimally Invasive Spine in Munster, Ind.; Scott Allen, vice president of managed care contracting at National Medical Billing Services; Heather Hilgendorf-Cooley, administrator at Spring Park Surgery Center in Davenport, Iowa; and Allison Stock, RN, executive director at Great Lakes Surgical Center in Southfield, Mich., discussed ways ASCs can facilitate contract negotiations with commercial payers at the Becker’s ASC Review 26th Annual Meeting in Chicago.
Four tips on negotiating payer contracts:
1. The importance of advocating for your own facility: “To [the payers] we’re just a number, so it’s our job to educate them on our services, quality, value and patients, and what the patients want because the patients are the ones paying premiums,” Ms. Davis said.
2. Be as specific as possible. Doing the research in the negotiation stages will stand to benefit your surgery center down the road. “Look at a 90 day out clause or an evergreen clause in your contract. Look at specific payer language in your contract in terms of unlisted codes and what not,” said Ms. Hilgendorf-Cooley. “Your three-page contract may end up being a 10-page contract but at you have everything covered.”
3. The ASC landscape is changing in terms of reimbursement and payer negotiations. Always keep your eyes open for new opportunities and be willing to change. “Whether that’s specialties or payers, there are so many things that are changing in healthcare right now,” Ms. Stock said.
Something that worked for your practice 15 years ago may not have the same impact in the future. “If you do that and put your head in the sand, you’re probably not going to be here in the next five years. Change is hard but it is important for your center to continue to thrive,” she added.
4. Keep your paperwork straight. “The biggest thing I see is people not having the complete managed care contract on file,” Mr. Allen said. “It’s important to be as organized as possible and have a complete file for every document.” Everything from amendments to crosswalks, compile and file them in a safe place to facilitate the billing team at your surgery center.
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Photo courtesy of: Becker’s ACS
Originally Published On: Becker’s ACS
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