How to Determine ASC Usual and Customary Rates for Out-of-Network Procedures: Q&A With Ken Bulow of GENASCIS

Ken Bulow is COO of GENASCIS.

 

Q: How do ambulatory surgery centers come up with usual and customary fees to bill insurance companies for out-of-network procedures?

 

Ken Bulow: We typically use one of the following methods:

 

  • Medicare times X percent where X can be 10-15 times Medicare.
  • Some percentage of the Ingenix rate for that area.
  • We will also use our proprietary MEDIBIS database to determine current prevailing market rates in the area.

 

Learn more about GENASCIS.

 

Read more from GENASCIS:

 

- 4 Best Practices to Control Labor and Supplies for Surgery Center Cases

 

- 4 Steps to Improve Collections Through Contractual Write-Offs

 

- 6 Steps to Improve Collection of Time of Service Patient Co-Pays

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