3 Tips for ASC's to Maximize Reimbursements

The industry-wide shift towards value-based care has put pressure on facility leadership to raise reimbursement levels for ambulatory surgery centers (ASC’s). The new operating environment pushes for both patients and payers to be attracted to providers that offer the best services at the lowest possible cost.

The challenge now for surgery centers is keeping their rates low while also working to raise their reimbursements. Here are 3 tips for ASC’s to maximize reimbursements amidst a changing industry landscape:  

1. Understand Your Market

Healthcare is a very dynamic industry; that’s why surgery centers need an in-depth understanding of their market. This involves knowledge of major players such as insurance companies, employers and other providers that operate within the center’s market.

By keeping track of the activities of these players, surgery centers can develop well-informed strategies to increase reimbursements. For instance, by conducting a study on the activities of these key market players, your center can identify insurance companies and employer groups that can form new partnerships.

Centers should also identify the payers and employers with the greatest coverage of their patients and understand the nature of the healthcare plans that they offer and their different operational dynamics. This will help in achieving greater efficiency in the claims management process.  

2. Keep Track of the Latest Trends in the Industry

Surgery centers cannot afford to be left out on the latest trends that cause significant changes in the industry, such as narrow networks and bundled payments.

Narrow networks are fast gaining popularity as employers seek for greater control in the way funds are disbursed from their plans. While the operation of these networks are analogous to that of managed care networks, the difference is that they mostly target particular providers or groups of providers by adopting yardsticks such as quality of service, accessibility, and cost of care. What this implies is that a center can be in-network with a payer but not necessarily be part of all of their narrow network arrangements.  

Another trend that surgery centers need to pay attention to is the growth in the adoption of bundled payments agreements. Bundled payment arrangements are poised to become an established alternative payment model in the near future. Centers should therefore embrace it as an integral part of their strategy to increase reimbursements.

3. Form New Partnerships

Entering into new partnerships with hospitals and physicians can be a great strategy to maximize reimbursements.

Entering into a partnership with physicians for instance would lead to an increase in case volume as a center can venture into new areas of specialty that gives it an edge over other operators. By forming partnerships with hospitals, ASC’s can also experience an increase in their case volumes as hospitals move procedures with lower rates to their centers.

David Hamilton is the CEO of Mnet Health Services, a Business Process as a Service (BPAAS) and Financial Technology (FinTech) firm with a specialized focus on End-to-End Revenue Cycle Management, Care Coordination, and Quality Assurance in the healthcare industry.