Payors may build in terms that limit or cap ASCs' ability to get paid for their services while providing the payors more revenue control. Here are five key factors to understand and negotiate into every payor contract.
1. All-product clauses. These allow the payor to extend the contract to other payors. If your payor has affiliates, ensure your contract includes an addendum that list all affiliates upfront at the time of signing.
2. Filing limit. Request a minimum of 120 days; it's also important to get an exception to the timely filing deadline for patients who provide inaccurate coverage information.
3. Appeal limits. The recommended minimum is 120 days in which to file an appeal.
4. Timely payment. Though many states have their own laws pertaining to timely payment, your contract should define a payment as 15 days upon receipt of a clean claim that has no defect, impropriety or special circumstance, and meets Medicare's guidelines for claim submission.
5. Recoupment time limits or takebacks. Avoid signing a contract that allows for unlimited overpayment recovery. Make sure there is a specific time frame in the contract — the shorter the better. It's only fair. The payor puts a time limit how long you have to file an appeal, so you should put a limit on the recoupment window.
Learn more about GENASCIS.
Read more insight and benchmarking data from GENASCIS:
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- Average Supply Costs for the Top Procedure by Specialty for Single-Specialty ASCs
- Average Total Time Per Patient at an ASC for the Top Procedure by Specialty