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Coding, Billing and Collections 39 4 Points on How ASCs Can Make Out-of-Network Contracting Work By Heather Linder K elly Webb, MediGain vice president and general manager of the ASC Billing Division, discusses how ASCs can grow revenue through analyzing payor mix and using both out-of-network and preferred provider organization insurance contracts. 1. Why OON contracting can work. Currently, nearly 204 million Americans, or 69 percent, have healthcare coverage through a PPO, Mr. Webb says, and the numbers will continue to grow as patients increasingly want to choose their specialists. HMOs are being phased out. "The selection of choices in PPOs is increasing," he says, "and huge premiums are being paid by employers." Going OON with certain providers is becoming more of a viable option for surgery centers looking to improve payments without alienating patients. PPO benefits have been paid for by the patient and the employer and should be used for a surgery, he says. 2. How to analyze payor mix. To ascertain how successful your center's current payor mix is, you can do a simple analysis of paid cases broken down per payor. By looking at the charges amount and number of cases, you can find the payor mix percent, average payment and percent of revenue, Mr. Webb says. Kelly Webb "If you are 100 percent Medicare-based or have a majority of Medicare contracts, you might want to look at changing or adjusting [that mix]," he says. "You can't grow in the industry without the resource of more money." Mr. Webb recommends only agreeing to payor contracts that are not tied to a Medicare fee schedule. Medicare reimbursements will continue to go down, and ASCs would in turn also lose money on cases with commercial payors that base reimbursements on Medicare rates. After analyzing the payor mix ASC leaders can determine how to work smarter by increasing the number of cases from the top paying insur- ance plans to get better revenue for the work they are already doing, he says. "Think of ways to drive more patients from your better payors to grow your business," he says. Develop Your Own ASC We'll help you get to the top! Meridian Surgical Partners works with physicians to successfully develop and manage multi-specialty and spine-driven ASCs. Partnership benefits include: • Excellent return on investment • Access to capital and experienced ASC partner • Maximized case volume and revenue • Decreased risk • Reduced management burden • Improved quality of life Contact us today to start your journey! Acquisition • Development • Management www.meridiansurgicalpartners.com 615-301-8142