The challenges behind anesthesia reimbursement contracts

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It's becoming increasingly difficult for anesthesia providers to secure adequate rates from many payers, Tony Mira, founder of Anesthesia Business Consultants, wrote in a blog post.  

Payer contracting has long been the strategy to secure reimbursements. Anesthesia providers traditionally have been focusing on contracts with commercial payers because public payer rates are nonnegotiable. 

But this strategy is losing momentum as many commercial insurance plans have begun pushing back and limiting annual increases, according to Mr. Mira. 

In a review of five-year payer plans, Mr. Mira and Anesthesia Business Consultants found that there is an overall downward trend in subsequent year rate increases in commercial payer contracts. 

Additionally, commercial insurance plans always involve a deductible and a copayment, typically 20 percent of the allowable. Because of COVID-19's financial toll on patients, anesthesia providers also are met with declining collections. 

Because of these statistics, Anesthesia Business Consultants renegotiate managed care contracts on an annual basis and include patient copays and deductibles in these discussions. Mr. Mira recommends that practices prioritize cost management above all else. 

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