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COVER STORY


intended to protect patients from bal- ance billing. This includes New Jersey, where Weiss’s ASC is located. “New Jersey passed a law in 2018 intended to regulate out-of-network billing that was branded under surprise medical billing,” he says. “The law included rules around notifying patients about network status, collections and pen- alties. As regulations come up, ASCs must determine how they apply to their situation.”


Protecting Patients ASCs should prioritize


minimizing


the number of surprise medical bills that reach their patients, Wilkins says. “The keys here are patient engagement and transparency. Determine what aspects of care that a patient is sched- uled to receive at your ASC is in net- work and out of network, then share this information with the patient prior to the procedure.”


ing staff members to serve as insur- ance coordinators who are tasked with confirming in-network status and helping patients make sound financial decisions.” Blaney also emphasizes the impor-


Assemble and maintain a list that


identifies which payers are in net- work with your ASC, its surgeons and any ancillary providers, Blaney says. “ASCs are increasingly assign-


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tance of performing patient insurance verification on the day of surgery. This is a recommended practice in normal times, he says, but one that has taken on greater significance during the pan- demic. “COVID-19 has caused sub- stantial economic upheaval. Job turn- over brings changes in insurance coverage. That increases the probabil- ity of someone going from in network to out of network between when they are scheduled for surgery and when they undergo the procedure.” Get in network with as many insur-


ance companies as possible, assum- ing doing so makes financial sense, Wilkins advises. “This will help reduce the likelihood of a surprise medical bill coming from your center.”


Future Trends Blaney says he is monitoring price transparency laws closely. “I look at this as being in a similar bucket as sur- prise medical billing. If patients are able to clearly determine what care is likely to cost before they go to a facil- ity, then they will not be surprised fol- lowing the visit.” While ASCs should strive to ensure patients do not receive sur- prise medical bills for services related to their surgery, this does not mean centers should welcome more out-of-network billing legisla- tion, Weiss says. “I am all for trans- parency but if you lose your ability to treat patients out of network, you largely lose your ability to negoti- ate commercial contracts. We do not want to end up in a place where ASCs are forced to be in network or take an unfavorable contract. I think it is important for ASCs to lobby for less control in this area.”


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