Ambulatory surgery centers (ASCs) can be a very attractive option for patients needing procedures that don’t require an inpatient stay. But declining Medicare reimbursement and competition from hospitals has made the business of running an ASC tough for owners and providers.
 
The solution? Having a payer mix that includes out-of-network payments, according to ASC billing experts. “We want surgeons to understand whether they should be in network with some payers and out of network with other payers, and how to really use that to their advantage,” says Suzanne Webb, co-founder of ASC Billing Specialists, in a recent article on Becker’s ASC Review.
 
Webb also suggests that ASC providers try to secure contracts that are based on usual, customary and reasonable (UCR) rates in their local market. Payers often push contract rates based on Medicare fee schedules instead, which is usually unattractive because Medicare reimbursements are low and getting lower.
 
Having a tool that shows you the local fair market UCR rates for your top procedures – like FeeCalc Professional – is critical to doing the type of payer mix optimization that Webb describes.
 
Tools like FeeCalc are used by billing experts and consultants to compare UCR rates against Medicare fee schedule rates (expressed as a percent of Medicare), and pinpoint exactly what rates to negotiate for in order to make a contract profitable, as well as which contracts should be accepted as-is.
Watch a free, interactive demo webinar showing FeeCalc Professional on May 15. You’ll see why you don’t need to pay a consultant to do contracting analysis.