Becker's ASC Review

24 Becker's ASC 21st Annual Meeting – The Business and Operations of ASCs – Call (800) 417-2035 In 1979 the Steelers won the Super Bowl. Saturday Night Fever was the album of the year. And AAAHC began accrediting ambulatory health care organizations. If you would like to know more about AAAHC accreditation, call us at 847-853-6060. Or email us at info@aaahc.org. Or you can visit our web site at www.aaahc.org. Improving Health Care Quality through Accreditation We've been raising the bar on ambulatory care through accreditation for 35 years. The secret of our success? Our peer review. AAAHC surveyors are physicians, nurses, anesthesiologists, medical directors and administrators. Which is why organizations routinely heap praise on us for our consultative and educational survey process. And why we are the leader in ambulatory accreditation. YEARS STRONG A rguably one of the more difficult responsibilities of being an ASC administrator is negotiating rates with payers. Here, three ASC ad- ministrators and one ASC payer negotiations specialist share their processes for ensuring fair reimbursement rates. Question: When is it best to negotiate rates with insurance com- panies? Susan Cheek, CPA, CASC, CHCC, Administrator, Dallas Endoscopy Cen- ter: Negotiating rates is an integral part of the insurance contracting pro- cess. The costs of providing quality services are rising, and you have to make sure your contracts are covering those costs. Dan Connolly, MHS, ARM, Vice President of Payer Contracting, Pinnacle III: Negotiating reimbursement is essential to optimize reimbursement and, ultimately, return on investment to your ASC. An ASC should attempt to negotiate reimbursement whenever possible and when in the ASC's best in- terest. Bruce Feldman, MS, CPPM, Administrator & Director of Operations, Island Endoscopy Center/Island Gastroenterology Consultants (West Is- lip, N.Y.): Insurance companies are always going to try to pay you the least amount possible. It's time to resort to rate negotiation when the reimburse- ment rates you are getting fall short of covering your costs. Gary A. Richberg, RN, BSN, ALNC, CMPE, CASC, Administrator, Pacific Rim Outpatient Surgery Center (Bellingham, Wash.): Facilities should al- ways plan on contract rate negotiations. Since the cost of medical care in- creases on a consistent basis, reimbursement patterns typically decrease as a standard rule as well. Q: How do you begin to organize, once you decide you will have to engage in rate negotiation? Ms. Cheek: I start by analyzing our costs for providing our services, and I also analyze our historical patient volume from a particular payer along with future volume to demonstrate impact to the payer. Mr. Connolly: I begin by assembling data on the potential case and procedure mix, identifying case costs and determining how existing contracts and associ- ated reimbursements compare to the proposed reimbursements. To do this, I look at a minimum of six months to one year of payment data, identify top- volume procedures and compare reimbursement by payers at the CPT level. Mr. Feldman: The first step is to understand your payer mix and to know what percentage of your patient population is represented by each type of payer. You need to know the costs of doing each type of procedure. It's also important to have a handle on your competition. You need to know how many other ASCs in your geographic area provide the same services that you do, both free-standing and hospital-based. Best Tips on Negotiating With Payers: Administrators Speak Up By Ellie Rizzo

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