Caryl A. Serbin, RN, BSN, LHRM, president and founder of Serbin Surgery Center Billing, suggests following these 10 best practices to help your ASC negotiate good insurance contracts for orthopedic, spine and pain-driven ASCs.
1. Rollover contracts from your joint-venture partner when possible.
2. Know your case costs before starting negotiations.
3. Discuss multiple procedure discounts.
4. Question your carrier's prompt-pay and timely-filing requirements.
5. Do not accept boiler-plate contracts.
6. Concentrate on carving out high-cost cases or changing the CPT to a higher paid grouper.
7. Negotiate implant reimbursement. Ensure you receive:
- a low threshold for each implant;
- at least cost plus shipping and handling; and
- no limitation on number of implants.
8. Discuss coverage of ancillary procedures, including:
- fluoroscopy;
- x-rays; and
- drugs and biologicals.
9. Do your homework (case costing) as some device-intensive spinal procedures require costly implants ranging from $3,000-$8,000 such as CPT 63655 (laminectomy with placement of neurostimulator electrodes) and 63685 (insertion spinal neurostimulator pulse generator)
10. Other spine procedures to consider when negotiating include:
- anterior cervical discectomy/fusion;
- laminectomies;
- discectomies; and
- laminotomies.
Learn more about Serbin Surgery Center Billing.
- 5 Quick Guidelines for Effective Insurance Verification
- 8 Best Practices for Contracting With the Right Insurance Plans
- 14 Recommended ASC Business Office Reimbursement Policies