Going out-of-network presents a new opportunity for healthcare facilities facing declining in-network reimbursement and CMS rates.
"There aren't a lot of opportunities to increase [ASCs'] reimbursements," CollectRx CEO John Bartos said at the Becker's ASC Review 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago. "Your in-network contracts are what they are — there's very little opportunity to increase those rates. Medicare and Medicaid is what it is. Out-of-network represents the last great opportunity for many providers to increase their reimbursement on out-of-network bills."
Other key reasons for going out-of-network, according to Mr. Bartos, are:
• Patients are increasingly demanding choice from their providers
• Every year, $60 billion in claims are paid out-of-network
• PPO enrollment will continue to grow
The decision to go out-of-network can be a tricky one for any healthcare facility. While the rewards are great — OON reimbursement tends to almost double the in-network rates — so are the risks. However, ambulatory surgery centers looking to go out-of-network need to keep abreast of legal and market developments.
In a CollectRx-sponsored webinar, Mr. Bartos will discuss a number of these developments, such as the impact of recent court cases and legislation on out-of-network coverage and how payers are using silent PPOs to decrease reimbursements.
Register for the webinar here.