Like other ambulatory surgery centers in New Jersey, Short Hills Surgery Center was once 100 percent out-of-network but has been under intense pressure from the state legislature and major payors to go in-network. Nancy Easley-Mack, business office manager of the eight-OR ASC in Millburn N.J., explained how it made the change to a hybrid ASC, with both in-network and out-of-network claims. She spoke at the 9th Annual Orthopedic, Spine and Pain-Management Driven ASC Conference in Chicago.
Negotiating with payors. Negotiations lasted for five months. "The language of the contract will drive your entire agreement," Ms. Easley-Mack says. "Don't be afraid to redline the boilerplate agreement again and again until you have a clear understanding of the payment guideline." In-network fees don't have to be a percent of Medicare, she said. They could be flat case rate, a percentage of billed charges or a percentage of group rates, and they should include carve-outs for implants, supplies and medications.
Two separate billing companies. With 65 percent of its business in-network and 35 percent still out-of-network, Short Hills uses two outsourced billing companies, one for each type of bill, which requires coordination between the companies. After a transition period, the ASC has seen a 30 percent increase in case volume, reduced A/R days and a predictable reimbursement for 65 percent of cases.
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