“Declining reimbursements are a huge factor,” she said. “Payers are forcing us to bundle more services together. I’ve been in this industry for about 30 years, and I’ve seen major changes in billing processes, codes and reimbursement structures.”
In addition to lower payments, negotiating contracts with commercial payers has become a longer, more drawn-out process.
“Each negotiation takes longer than before, and we’re seeing more delay tactics from payers,” she said. “For example, we had a payer sending payments to the wrong address for over a year and refusing to correct it, despite multiple requests.”
The administrative burden of resolving these issues can seem overwhelming, she added.
“It’s almost unbearable,” she said. It takes months, even years, to resolve issues.”
For smaller ASCs with limited resources, these payer challenges can be a serious threat to viability.
“If you don’t have financial security, and we’re a small surgery center, you can only sustain this for so long,” she said. “This past year, we’ve had to put more manpower into chasing these issues down. It’s extremely frustrating.”
Navigating these challenges requires persistence, but the process remains frustratingly inefficient.
“It’s hard to reach the people who actually have the power to make changes,” she said. “Most of the time, we’re dealing with people who are just processing paperwork. I think they’re probably overwhelmed themselves.”
