Caryl A. Serbin, RN, BSN, LHRM, president and founder of Serbin Surgery Center Billing, suggests following these eight guidelines to help ensure your ASC contracts with insurance plans best for your facility.
1. Gather information about potential plans, including:
- market share
- history in your market
- types of products (PPO, HMO, POS)
- breakdown of members by type
2. List the plans in order of those with the largest number of contract holders in your area.
3. Next choose the plans that make up large patient volumes for your referring physicians.
4. Don't contract with a plan under which your ASC will lose money in order to attract physicians.
5. Choose PPOs that steer members to your facility in return for a discounted price.
6. Five things to look for in choosing a PPO:
- Has a current provider directory
- Provides a list of payors
- Members have ID cards with a number to verify eligibility
- Requires credentialing of providers
- Has set fee schedule
7. Choose well-known plans to begin your negotiations (i.e., Blue Cross, Aetna, UHC, etc.).
8. Determine financial stability of lesser-known plans by checking with your state insurance commissioner.
Learn more about Serbin Surgery Center Billing.
Read more insight from Caryl Serbin:
- 14 Recommended ASC Business Office Reimbursement Policies
- 7 Quick Guidelines to Follow for Successful Collections
- 8 Steps to Ensure Payment From Patients With Insurance