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3. How to explain OON to patients. Before discussing OON benefits with patients, first begin with the general benefits of having surgery
at an ASC versus at a hospital. Hospitals derive revenue from many more
sources than an ASC so their cost is always higher. ASCs also have lower
infection rates, on-site registered nurses and on-site physicians until patient
checkout.
"People want to go to the best," Mr. Webb says. "The benefits of OON or
an ASC are worth it compared to a hospital."
He recommends having an insurance coordinator explain plan benefits and
costs to patients prior to and following surgery, which will put them at ease.
Print out the patient's benefits and walk them through it.
"Do it days before," he says. "Set their expectations so it's not a surprise
later. Have the cost spelled out to the best of your ability."
4. Avoid insurance manipulation. Insurance pre-verification is essential to getting OON claims processed. Many insurance companies have
their own policies on how and when to pay. Surgery center leaders should
educate their revenue cycle personnel on what questions to ask to properly
verify benefits and avoid any denials or unpaid claims. Mr. Webb highly
encourages billers to ask insurance company representatives how they will
determine the allowable for OON.
ASC leaders also need to be vigilant to avoid contract manipulation. For
example, some contracts may only agree to pay one charge line when many
procedures require multiple charges, which is unfair. Other potential issues
include hidden enrollments and hidden networks.
Coding, Billing and Collections
Have a healthcare lawyer review all contracts for fair terms prior to signing,
Mr. Webb says.
"Feel free to push back on the terms," he says. "See what you are getting
paid on the 4th and 5th line of the CPT charges in your area. You might be
surprised how things are treated." n
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