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collections,” LaPlante says. “Strong individuals with the ability to argue respectively and be assertive will force payers to listen and execute claims properly. It can be discouraging how many hoops payers make you jump through. When you have people will- ing to go that extra mile, it is a strong determinant to success.”


Come prepared with data to sup-


port your argument that the payer is at fault, Copeland says. If your contracts are loaded and your practice manage- ment system is set up properly, you should be able to export information that shows what your ASC was paid versus what it is owed. “Sharing this data is essential when your ASC expe- riences a recurring problem,” she says. “If you hope to convince a payer that they need to fix something on their end, anecdotal arguments will not get you a response. You need evidence.” There are ways ASCs can help


Get Paid on Time, Every Time Ways to hold payers accountable BY ROBERT KURTZ


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ubmitting clean claims to payers in a timely manner does not ensure getting paid appropriately. The com- plicated nature of insurance leaves a lot of potential for errors. “When payers make mistakes, we cannot depend on them to catch and correct these issues,” says Teresa Copeland, director of payer contract- ing and surgical services for Knoxville Orthopaedic Surgery Center in Knox- ville, Tennessee. “Rather, it is up to us to spot errors and take the necessary steps to collect what our ASC is owed.” Doing so


requires getting your


house in order, says Jed LaPlante, administrator for the Center for Spe- cial Surgery in Fargo, North Dakota. “Understanding your payer contracts is probably the most important way to hold payers accountable. If you are


32 ASC FOCUS MAY 2020 | ascfocus.org


like us and have only a few big payers, then you can scan incoming remits and get a feel for whether payers are pay- ing as agreed upon in the contract.” Allocate the time to carefully load payer contracts into your practice man- agement system and keep them current, Copeland says. “When payment posts, you should immediately know whether you received what you expected and deserved, and if not, you can start work- ing on a correction right away.” Sometimes fixes are straightfor-


ward, requiring the resubmission of a claim or filing an online appeal, but when simple solutions do not work or are not an option, you might need to rely on your talent. “Having dedicated team members willing to fight for the money your ASC has earned is going to be a make-or-break factor in your


make these conversations go smoother, LaPlante says. “Build relationships with your contract contacts and pro- vider relations team. An established relationship with key contacts is helpful so that you are not addressing problems with a team that does not know you. “While holding payers accountable


is not always 100 percent effective, we have seen success on overturning payer denials and correcting underpay- ments,” LaPlante adds. Track the time staff spend on spe-


cific follow-up efforts as well as any other expenses, such as mailings. You might want to share this data during another discussion with a payer. “If I have a higher-paying contract with payer A than payer B, but I need to con- stantly and repeatedly appeal claims with payer A, its contract may not be as good as it seems,” Copeland says. “The next time we sit at the negotiat- ing table with that payer, we can show that they cost us a lot of personnel time and money, then push for a pay bump or meaningful changes.”


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