Challenges with ASC Insurance Contracting vs. Out of Network Billing

Event Information
Product Format
Prerecorded Event
Conference Date
Wed, Feb 28, 2018
60 minutes
Product Description

Tips and Tricks for Ensuring a Successful Negotiation with Medicare and Third Party Players

According to CMS, for Medicare purposes, Ambulatory Surgical Centers (ASCs) are distinct entities that exclusively provide surgical services to patients who do not require hospitalization and where the duration of services does not exceed 24 hours following admission. This definition applies to ASCs regardless of who the payer is. According to the HHS, Office of Inspector General, Medicare sets minimum health and safety requirements for ASCs through the conditions for coverage and CMS requires that ASCs become Medicare certified to show they meet these conditions. Over time, many ASCs have taken the out-of-network route; however, increasing price pressures and decreasing reimbursements mean that ASCs must think carefully and then decide the best route for their business.

Join this live webinar with expert speaker Stephanie Thomas to discover the top trends ASC facilities are facing with contracting with Medicare and third party payers. You will also get tips and tricks to ensure your negotiations are successful. You will learn to weigh the pros and cons of contracting to decide if out-of-network billing may be the best route for your business.

By attending this session, you will feel confident when making a submission for a new contract. You will be able to understand the importance of risk and cost to payers during the contracting process. You will understand what payers look for, and how to effectively communicate with them. You will get tips and tricks for billing out of network and why this may be the best option for your bottom line. You will also learn how to read contracts and understand what your rights are for renewals.

Session Highlights

This session will discuss:

  • Length of time to expect for contracting
  • What data is important to submit with your request
  • Specific contract terms to watch for
  • How to prove value to the payer
  • How to negotiate “carve-outs”
  • How to terminate a contract
  • Out-of-network billing tips and tricks

Session Agenda

This session will cover:

  • Myths about out of network
  • Medicare contracting
    • Mandatory documentation to be included
  • Medicaid contracting
  • Blue Cross contracting
  • Triwest or Tricare plans
    • Difference between TRICARE-certified and TRICARE-contracted
  • Commercial payers
  • Narrow networks
    • Contract verbiage for narrow networks
    • Impact of narrow networks on your bottom line
  • What to include with your initial application
  • How to prepare your negotiations
  • How to negotiate carve outs
  • Warning signs for contracts
  • Pros and cons of out-of-network billing
  • How to terminate a contract

Who Should Attend

  • ASC Administrators
  • Physician ASC Owners
  • Billing Managers
  • Credentialing Administrators/Support

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Stephanie Thomas

Stephanie Thomas is the Billing Director for CE Medical Group, a third party billing and consulting firm. Stephanie has been in the medical field for nearly 20 years. Her experience includes private practice administration, medical billing for several specialties, practice management consulting for numerous physicians and ASC’s across the nation.

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