According to Amy Mowles, president and CEO of Mowles Medical Management, ASCs can improve their contracts with payors by simply doing adequate research about costs and regulations beforehand. Your ASC may be able to ask for higher fees if a deadlock — and the possible loss of the payor contract — would not hurt your facility.
"The more you ask in a negotiation, [with either a] new or renewed contract, the more likely it becomes that the negotiation will end with either a large favorable settlement or a deadlock," Ms. Mowles says. Before you start negotiating, do your research on the value of the specific payor contract to your center. How much of a market presence does the payor have? Does your center treat a significant number of the payor's enrollees? If losing the contract will not significantly damage your center, you can afford to ask for more fee increases.
Once you know you can afford to negotiate, Ms. Mowles recommends researching your costs and identifying several fees that are "significantly too low." In order to do this research, Ms. Mowles recommends a few different resources, including the 2010 MGMA Cost Survey for Single-Specialty Practices and the 2010 Cost Survey for Multi-Specialty Practices.
"I focus on a few specific issues, like two or three fees that are significantly too low," she says. "If a plan refuses to negotiate, I go up a level in the plan and complain about unprofessional attitudes, especially if the plan or representative is being silent and unresponsive."
Ms. Mowles says your ASC also needs to be aware of government regulations before beginning negotiations. While Medicare regulations do not bar providers from sometimes collecting payment rates lower than Medicare rates, regulations from the Office of the Inspector General do bar providers from charging Medicare rates that are "substantially in excess of the provider's usual charges," she says. "It may be okay to accept if you have other contracts that reimburse you at rates equal to or greater than Medicare's," she says. "[But] agreeing the discounts substantially below Medicare rates for all your contracts could risk an OIG investigation."
Learn more about Mowles Medical Management.
"The more you ask in a negotiation, [with either a] new or renewed contract, the more likely it becomes that the negotiation will end with either a large favorable settlement or a deadlock," Ms. Mowles says. Before you start negotiating, do your research on the value of the specific payor contract to your center. How much of a market presence does the payor have? Does your center treat a significant number of the payor's enrollees? If losing the contract will not significantly damage your center, you can afford to ask for more fee increases.
Once you know you can afford to negotiate, Ms. Mowles recommends researching your costs and identifying several fees that are "significantly too low." In order to do this research, Ms. Mowles recommends a few different resources, including the 2010 MGMA Cost Survey for Single-Specialty Practices and the 2010 Cost Survey for Multi-Specialty Practices.
"I focus on a few specific issues, like two or three fees that are significantly too low," she says. "If a plan refuses to negotiate, I go up a level in the plan and complain about unprofessional attitudes, especially if the plan or representative is being silent and unresponsive."
Ms. Mowles says your ASC also needs to be aware of government regulations before beginning negotiations. While Medicare regulations do not bar providers from sometimes collecting payment rates lower than Medicare rates, regulations from the Office of the Inspector General do bar providers from charging Medicare rates that are "substantially in excess of the provider's usual charges," she says. "It may be okay to accept if you have other contracts that reimburse you at rates equal to or greater than Medicare's," she says. "[But] agreeing the discounts substantially below Medicare rates for all your contracts could risk an OIG investigation."
Learn more about Mowles Medical Management.