DOING BUSINESS
otherwise, the agreement will be voided and the claim will need to be paid in full. Second, make certain that the agreement states that both parties are entering into this agreement in good faith and that the carrier releases the prac- tice/facility from all audits and retractions just as the practice/ facility is prohibited from all ap- peals and from balance billing the patient for all non-covered services, except for any deduct- ible and co-insurance. Both the carrier/negotiator and the ASC need to sign off on this compo- nent of the agreement. Make sure to specify that the payment comes directly to your ASC; if it goes to the patient, the negotiation is nul- lified and the carrier will become responsible for the entire balance.
5. How can I make all that hap- pen? Negotiation companies and the carriers that they represent have a vested interest in reaching an agreement with your ASC. In general, negotiation companies are paid a commission on savings resulting from reduced carrier payments when the negotiation is successful. When the patient bal- ance is reduced and the surgeon/ facility has received a fair settle- ment for the services rendered, in the true spirit of negotiation, all parties are satisfied as long as all parties keep their promises.
6. What do I do with a negotiation that is unfair or unreasonable? Do not accept any contract that you are not comfortable with or believe will not be acted upon in good faith to reduce the patient li- ability or remove any risk of an au- dit or potential payment retraction in your ASC. Most negotiations void out the ability of the practice to appeal payments or fight re- funds. If you do not feel that both
ASC FOCUS NOVEMBER/DECEMBER 2013 29
If you do not feel that both the patient and the
practitioner are protected, say ‘no’ to the offer.”
— Barbara Cataletto, Business Dynamics Inc.
the patient and the practitioner are protected, say “no” to the offer. Hold out for a better offer/position until you are satisfied or refuse the offer in total. By doing so, your opportunities to appeal underpay- ments or denied codes will remain available to you.
Being aware of the opportunities
to negotiate case payments can benefit your patients and your ASC. Do not accept the first offer as a way to close
Barbara Cataletto is the chief executive officer of Business Dynamics Inc. of Mineola, New York,
www.businessdynamicsrcm.com.
the case. Do not accept any offers if you are deep into the reimbursement process and have filed complaints to the insurance commissioner of your state. Hold out for reasonable and customary payments that reduce the patient liability, and make sure that the payment is received in an accept- able amount of time.
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