The beginning of the Patient Protection and Affordable Care Act resulted in millions of Americans becoming insured on plans with out-of-network benefits. Also, this act has narrowing insurance networks which left many providers completely out-of-network. Therefore, the out-of-network strategy for ASC is only revenue enhancing strategy for some ASCs.
There are some key opportunities available with out-of-network offerings and you will get the details of opportunities in the following briefs:
The rise in overall reimbursement
The changing and sometimes volatile world of insurance can be stressful for practitioners who desire a more predictable income stream. Fortunately, there are some ways exist to improve your reimbursements and it starts with developing a good out-of-network strategy combined with the right expertise.
You can avail the best pay-off by creating a hybrid strategy which includes out-of-network and in-network strategy. Moreover, you can enhance revenues by making out-of-network payments a small part of your surgery center business.
Lastly, the marketplace plays an important role while implementing a hybrid model to maximize revenue and you need to determine which payers to pursue this strategy with based upon reimbursement levels compared to the levels of reimbursement if your surgery center was in-network with that payer.
Rising certain market trends
According to a study around $60 billion of out-of-network claims are getting processed every year and this data is enough to let you understand the out-of-network strategy for ASC is a future. Moreover, certain market trends will boost the opportunities for out-of-network ASC benefits. For example, Continuous growing PPO enrollment driving patients to pursue out-of-network opportunities. Lastly, people are willing to pay for out-of-network benefits, and payers continue to offer them.
PPO is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Higher rate of reimbursement compared with contracted reimbursement rates
When it is out-of-network cases then reimbursement rates are likely five times as high as contracted reimbursement rates. Hence even if you only have a very small percentage of out-of-network cases, it can make a significant difference in your surgery center’s revenue. This higher rate of reimbursement can account for a large percentage of your reimbursements each year, boosting your bottom line.
Maximize your investment
Many ASC is always looking for maximizing their investment and it can be achieved easily with experts who are having the right training and experience. When you try going out-of-network without the right training and experience, it can be difficult to succeed, which is why it can be helpful to outsource your out-of-network billing to a company like Medical Billers and Coders that has plenty of experience handling various complex claims.
Finally, payers’ declining reimbursements make it impossible for some providers to accept in-network patients and continue to remain in business, forcing them to consider an out-of-network strategy as a means of survival. In brief, a combination of rising potential out-of-network ASC patients and reduced payments mean out-of-network must be a part of a centers strategy.
If you are looking for an out-of-network strategy for ASC then partnering with medical billing company like Medical Billers and Coders will benefit you for claim settlement and reimbursement as we have demonstrated 95% clean claim submission.