1. Present your patient satisfaction scores during payor negotiations. "Put your best foot forward" and present your patient satisfaction scores upfront, said Reed Martin, chief operating officer for Surgical Management Professionals. He said it's important to have patient satisfaction as an agenda item for quarterly board meetings and then to use this information with your payors.
The surgery center should be thinking about how to improve the patient experience on a regular basis — and payors want to know that. "ASC patients are managed care members, and payors want to know how your facility compares to other hospital systems or other ASCs," he said.
2. Incorporate device-intensive procedures. Cardio simulator and pacemaker procedures, urology procedures, neurostimulator-related spine and pain management procedures and some ophthalmic and ENT device-intensive procedures are seeing greater reimbursement from Medicare in the ASC setting, said Cathy Weaver, senior manager at Somerset CPAs in Indianapolis. This type of reimbursement continues to be enhanced to account for the high cost of performing these surgeries, she said. Incorporating more of these procedures can bring higher reimbursements from Medicare.
3. Understand how your charges and reimbursement compare with the HOPD. How do your charges and reimbursement compare with the local hospital outpatient department? Mr. Martin said this question is essential to effective contract negotiation.
"We know hospitals are paid 40 percent more by Medicare, and oftentimes considerably more by managed care," he said. "It's important to be able to discuss the lower reimbursement that ASCs receive, and translate that to savings to the members and insurance companies."
He said you can either estimate the amount the hospital receives, or you can work with patients who are willing to show you their EOBs. Payors may be more willing to give you a good reimbursement rate if they understand that you save them money when cases go outside the hospital.
4. Monitor your payor contracts. Review payor mix monthly by contract and by physician. Look at the rates you're receiving from your payors on a monthly basis, said Jessica Nantz, president and founder of Outpatient Healthcare Strategies. "You should look at the rates you're being paid by contract and by physician," she said. "That predicts your net revenue — in a month, there's a huge difference in net revenue depending on whether you're reimbursed at $400 or $600 for GI cases, or $2,000 or $3,000 for shoulder cases."
She also recommends reviewing top 12 payor contracts (one per month). Review one payor contract a month to determine whether the payor is reimbursing your center in a timely fashion, and whether you could stand to re-negotiate the contract for a payment increase. For example, if the cost of your supplies has gone up in the past year, you will see upon reviewing the contract that your payor no longer reimburses an adequate amount to cover your costs.
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The surgery center should be thinking about how to improve the patient experience on a regular basis — and payors want to know that. "ASC patients are managed care members, and payors want to know how your facility compares to other hospital systems or other ASCs," he said.
2. Incorporate device-intensive procedures. Cardio simulator and pacemaker procedures, urology procedures, neurostimulator-related spine and pain management procedures and some ophthalmic and ENT device-intensive procedures are seeing greater reimbursement from Medicare in the ASC setting, said Cathy Weaver, senior manager at Somerset CPAs in Indianapolis. This type of reimbursement continues to be enhanced to account for the high cost of performing these surgeries, she said. Incorporating more of these procedures can bring higher reimbursements from Medicare.
3. Understand how your charges and reimbursement compare with the HOPD. How do your charges and reimbursement compare with the local hospital outpatient department? Mr. Martin said this question is essential to effective contract negotiation.
"We know hospitals are paid 40 percent more by Medicare, and oftentimes considerably more by managed care," he said. "It's important to be able to discuss the lower reimbursement that ASCs receive, and translate that to savings to the members and insurance companies."
He said you can either estimate the amount the hospital receives, or you can work with patients who are willing to show you their EOBs. Payors may be more willing to give you a good reimbursement rate if they understand that you save them money when cases go outside the hospital.
4. Monitor your payor contracts. Review payor mix monthly by contract and by physician. Look at the rates you're receiving from your payors on a monthly basis, said Jessica Nantz, president and founder of Outpatient Healthcare Strategies. "You should look at the rates you're being paid by contract and by physician," she said. "That predicts your net revenue — in a month, there's a huge difference in net revenue depending on whether you're reimbursed at $400 or $600 for GI cases, or $2,000 or $3,000 for shoulder cases."
She also recommends reviewing top 12 payor contracts (one per month). Review one payor contract a month to determine whether the payor is reimbursing your center in a timely fashion, and whether you could stand to re-negotiate the contract for a payment increase. For example, if the cost of your supplies has gone up in the past year, you will see upon reviewing the contract that your payor no longer reimburses an adequate amount to cover your costs.
More Articles on Coding, Billing and Collections:
Accretive Health Replaces Founder, Names Stephen Schuckenbrock CEO
Payment on ASC April Medicare Claims Delayed Two Weeks
CMS Changes Gear to Raise, Not Lower, 2014 Medicare Advantage Rates