AS I SEE IT
claims because your physicians are not credentialed into that network. The managed care organizations are also including language that reserves their right to include your participation in their narrow networks. While this can positively impact your ASC by driv- ing volume to your facility, if you are not carefully negotiating your contract and understanding this language, you could end up with a contracted rate in the narrow network that is lower than your standard rate with the managed care organization.
are
Some managed care organizations including language
restricting
your ability to contract directly with employer groups, which, depending on your market, could be a beneficial arrangement for you. In this situation, you are being viewed by the insurance company as competition.
Some high-performing narrow
networks are also implementing addi- tional credentialing requirements that are making it even more burdensome to be included. Because credential-
Pressure from self-funded employers has forced managed care organizations to tighten up their contract language, and if you are not aware of these trends, you could see a direct impact on your reimbursement rates and revenue.”
— Kylie Kaczor, RN, CASC National Medical Billing Services
ing is not necessarily a quick and easy process, it is easy to see how this additional work will be taxing to facility resources.
Summary State laws are changing rapidly as health care reform continues. At the same time, consumers and employers are exploring new options for cost sav- ings and coverage. During this period of rapid and often unpredictable change, successfully launching or managing an ASC requires a great deal of diligence, regulatory and compliance insight, and professional guidance.
Kylie Kaczor, RN, CASC, is the vice president of clinical and regulatory affairs at National Medical Billing Services in St. Louis, Missouri. Write her at Kylie.Kaczor@
nationalascbilling.com.
ASC FOCUS OCTOBER 2018 |
www.ascfocus.org
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