Naya Kehayes, managing principal & CEO of Eveia Health Consulting & Management, a managed care contracting consulting firm, suggests GI ASCs follow these two critical managed care contracting tips.
1. Stay on a grouper payor methodology. "Be on the lookout for payors that want to put you on the 'current Medicare payor methodology,'" says Ms. Kehayes. "APC methodology — which is the current Medicare methodology for ASCs — is less favorable than the grouper methodology for GI."
2. If moving to the APC system, understand what percentage increase on the new Medicare methodology equates to the center's current payment rates. For example, 130 percent of a grouper rate is going to be higher than 130 percent of an APC rate for GI cases. Centers, therefore, must know what percent of APC rates will be equivalent to their current reimbursement rate. In addition, if the payor is moving with transitional weights on APCs, the reduction in 2011 will be even greater. Thus, the APC weight year should be locked in when negotiating with the payor. Further challenging GI ASCs, HOPD APC rates for GI cases may actually be lower than ASC rates based on old grouper methodology. This could make ASC negotiations much more challenging in markets where hospitals have switched to the APC system, says Ms. Kehayes.
Read more best practices to improve GI profitability and efficiency:
- Case Study: Direct Access Colonoscopy Program Increases ASC Colonoscopy Compliance Rate
- 4 Best Practices to Improve the Patient Experience in a GI ASC: Mirage Endoscopy Center
- 8 Ways GI Centers Can Prosper in the Next Five Years
Learn more about Eveia Health Consulting & Management.
1. Stay on a grouper payor methodology. "Be on the lookout for payors that want to put you on the 'current Medicare payor methodology,'" says Ms. Kehayes. "APC methodology — which is the current Medicare methodology for ASCs — is less favorable than the grouper methodology for GI."
2. If moving to the APC system, understand what percentage increase on the new Medicare methodology equates to the center's current payment rates. For example, 130 percent of a grouper rate is going to be higher than 130 percent of an APC rate for GI cases. Centers, therefore, must know what percent of APC rates will be equivalent to their current reimbursement rate. In addition, if the payor is moving with transitional weights on APCs, the reduction in 2011 will be even greater. Thus, the APC weight year should be locked in when negotiating with the payor. Further challenging GI ASCs, HOPD APC rates for GI cases may actually be lower than ASC rates based on old grouper methodology. This could make ASC negotiations much more challenging in markets where hospitals have switched to the APC system, says Ms. Kehayes.
Read more best practices to improve GI profitability and efficiency:
- Case Study: Direct Access Colonoscopy Program Increases ASC Colonoscopy Compliance Rate
- 4 Best Practices to Improve the Patient Experience in a GI ASC: Mirage Endoscopy Center
- 8 Ways GI Centers Can Prosper in the Next Five Years
Learn more about Eveia Health Consulting & Management.