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ASC Managed Care Contracting: 10 Tips for Success

Jho Outlaw

September 4, 2020 By Jho Outlaw

Bio

 

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I, along with Jessica Nelson, the director of revenue cycle services here at Surgical Information Systems, had the pleasure of hosting a webinar this week that focused on managed care contracting in an ambulatory surgery center (ASC) setting. A career spent in the revenue cycle services industry has afforded me an abundance of experience in dealing with managed care contracting, and I would like to share my top 10 tips to help you find success on your journey!

  1. Preparation is key.
    As with most situations is life, I believe that preparation is key. Gather both internal and external data and try to truly understand your ASC’s direct and indirect costs, your competitive advantage among other ASCs, what plan types the payers offer, state fees, Medicare rates, CMS fee schedules, and more. Review all the data you have access to or can locate, and research the payers you are looking to target. Before any other step, get yourself prepared.
  1. Organize your research.
    Now that you have the data gathered, it is time to organize. Lay it all out in an easy-to-understand format so there will be no fumbling when it comes time to negotiate with payers. If you understand the payer’s market and reimbursement methodology, and what type of contracts they offer before you begin the conversation, there won’t be any unpleasant surprises.
  1. Set goals & timelines.
    Outlining timelines and setting reasonable goals to stay on track and meet deadlines is very important in this process. Keep in mind there are many factors that could affect the timeline you have outlined. Are you a new site, or are you an established facility? Is it a busy time of year? There may also be unforeseen delays due to issues with COVID-19. As long as you have reasonable expectations and stay on top of it, you will be successful.
  1. Be confident.
    You have heard it before, but I cannot stress enough that confidence is key when going into a negotiation with a payer. Remember, you have taken the time to gather all of the pertinent data needed to make an informed decision, so you are prepared. Also keep in mind that the payers need you just as much as you need them.
  1. Expect more but be reasonable.
    In the research and organization step of this journey, you will have calculated a bottom-line number before you go into negotiations. You know what you have to walk out with in the worst-case scenario, but don’t be afraid to ask for more than just the bottom-line in discussions with the payer. My advice though, is always work within reason. Payers will be more likely to work with you if you do not have outrageous requests.
  1. Find a “friend” within the payer team.
    As I mentioned before when talking about having confidence when    negotiating, the payers need you just as much as you need them. Without patients, payers, and facilities, there would be no insurance business to exist. So, my suggestion is to build relationships with the payers and find common ground to connect on. For example, I used to have a contract negotiator who would spend afternoons on the golf course with our payers to form that bond. Though this tactic may not be as necessary in today’s world, it gives you an idea of extracurriculars that can help build those relationships.
  2. Keep the payer business model front and center.
    The more you can make your negotiation about the payer, the more attention you are likely to get and ultimately the more success you will find. Make sure the payer understands you view this as a partnership, rather than a competition.
  3. Be willing to “give some to get some.”
    As with any negotiation, you must be willing to compromise.
  1. Set the stage for routine discussion.
    Once you have the contract set, the work is not over. This is an ongoing responsibility. Set expectations from the start to check in frequently with the payer to measure progress and discuss any misinterpretations either party may have run into post-agreement.
  2. Keep payer contracting part of the routine.
    Again, payer contracts are not a “one and done” initiative. A mistake I see being made time and time again is people forgetting about re-negotiations due to the use of evergreen clauses within the contract. Now don’t get me wrong, evergreen clauses are a good thing and we like to see them, they mean the contract will continue; however, do not let them make you complacent. My advice is to keep an in-view calendar on your wall with a reminder to revisit those contract negotiations every once in a while, and make sure there aren’t things you’re missing out on.

    For an in-depth look into why it’s important to contract with payers and first steps your ASC can take, you can watch the presentation in its entirety here.

    I would also like to invite you to join the next two webinars in our revenue cycle services series! You can register for Now is the Time to Outsource Your Revenue Cycle on September 30th, and Patient Collections: Challenges, Opportunities, and Best Practices on October 28th, both at 3:00 PM ET.

Topics: Revenue Cycle Management

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