AS I SEE IT


percent of individuals “who bought an ACA plan for the first time this year reported that they did not know the network configuration associated with their plan.”


It is also an issue that will likely


worsen in the coming years. McKin- sey projections published in 2013 state that the individual health insurance market in the US—which represented only 5 percent of the US population in 2010—might expand to 11 percent, or 36 million people, by 2019. As a result, many providers will be OON under these plans.


Providers: What Shall They Do? Providers


can best protect them-


selves legally, and put themselves in a favorable business position, by being highly methodical in their upfront preparation. They should develop,


By understanding what individual payers require, as well as the applicable local and federal laws, ASCs that choose to be OON can develop a well-designed OON program to carefully maneuver through today’s complex, ever-changing legal landscape.”


—Nader Samii, National Medical Billing Services


along with knowledgeable counsel and advisers, a state-of-the-art reg- istration packet that complies with all state and federal laws. At a mini- mum, it should include an assignment of benefits form that contains detailed Employee Retirement Income Secu- rity Act of 1974 (ERISA) assignment language, clear notification forms regarding the ASC’s OON status and the providers’ financial interest in the


New 2015 Malignant Hyperthermia Recomendations


1 It’s Easy! Are You Compliant?


If you use anesthesia machines to deliver gas to your patients, using the Vapor-Clean can save time, money and keep you in compliance with new recommendations.


New literature suggests MH-susceptible patients can be safely treated in an ASC if these new guidelines are followed.2


The Vapor-Clean is designed to prevent exposure to MH-triggering agents without lengthy flushing.


And more importantly in an ASC, the Vapor-Clean is a key part of the new algorithm for managing an actual MH-crisis.1


Call 801-484-3820 and Mention ASCA for Special Discount


Available in a carton of 3 pair and a carton of 8 pair.


1. MHAUS website: www.mhaus.org 2. Malignant Hyperthermia in the Ambulatory Surgery Center, How Should We Prepare? Litman RS, Joshi GP, Anesthesiology. 2014 Jun;120(6):1306-8.


www.dynasthetics.com/ASCA 801-484-3820


ASC FOCUS OCTOBER 2015 9


ASC, a patient responsibility estima- tion form and indigency or medical indigency forms, if appropriate. The ASC should also be certain to request the summary plan descrip- tions for each of the benefit plans so that its business office understands exactly what should and should not be reimbursed. Just as importantly, the ASC should have a financial counselor explain the entire process, including


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