At Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago, Richa Singh, executive vice president of Collect Rx, advised ASC leaders on how to effectively negotiate out-of-network agreements.
Below are four key frequently asked questions presented during the June 15 conference session, followed by Ms. Singh's answers:
1. Why would I want to be out of network?
"It's more money. Out-of-network negotiations have become harder. You have to put more time into it, and you have to have more data. It takes a lot of persistence, but in the end, it is going to be more money."
2. Is it worth the trouble negotiating if we don't see a lot of out of network?
"We hear this a lot from providers, especially those with only 10 percent of patients out of network. The answer is yes. The amount that you can negotiate on out-of-network bills is so large that there is enough room to cover the cost of one or two full-time employees."
3. My revenue cycle team insists that "usual and customary" is limited to 150 percent of Medicare or lower for out of network. What are your thoughts?
"That can't happen. There is no way that in one area every single payer is reimbursing at the same amount. Remember, employer groups purchase all different types of policies, and unless they all got together and said, 'We're going to purchase the same policy,' you're going to be seeing varied amounts."
4. Given that there is no contract, what is the incentive to agree to a proposal when the provider is out of network with the payer?
"We hear a lot of the time, 'No, we don't negotiate. We don't believe in negotiating.' But these negotiations are like gold in your hand. You should be negotiating them. You want to, because these are the policies that the employer groups are paying more for."