At the 11th Annual Orthopedic, Spine & Pain Management-Driven ASC Conference in Chicago on June 15, Healthcents President and CEO Steve Selbst gave a presentation titled "Vendor Market Intelligence — An Industry Overview of ASCs."
During this session, Mr. Selbst discussed three scenarios for ASCs purchasing medical equipment: buy and bill, third party channels and direct payer contracting. All processes impact the revenue cycle and allow providers to increase sales.
Buy and bill critical success factors:
• Identify CPT codes that are billed by your ASCs and practices that require use of your products and/or services.
• Identify key payer contracts that care the most revenue for your products/services through a CPT code revenue analysis.
• Determine the current Medicare benchmark for the CPT codes that carry your products.
• Bid an overall payer contracting strategy for your client to raise their reimbursement for the CPT codes which carry your products and for other products.
Third party channel critical success factors:
• Identify a company that has broad reach and already sells similar products and services to your target market.
• Assess royalty agreements based on the go-to market strategy
• Assure channel conflict is considered and can be managed as a "co-operation."
• Make sure that the third party reseller has the provider and payer relationships in place and motivation to sell your products.
Direct payer contracting critical success factors:
• Map your go-to market strategy by state to determine the areas of the country that will help you maximize reimbursements through payer contracts.
• Determine whether or not the payer/Medicare have unique CPT codes to bill for your products/services and avoid generic CPT codes.
• Leverage current patients and real cases as a key reason to put in place local contracts.
• Make sure to bill for products, education and services.
• Benchmark your payer rate proposals and offers based on available data and local Medicare rates.
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