Outpatient Surgery Magazine - Subscribers

Difficult Airways - April 2015 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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3 4 O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | A P R I L 2 0 1 5 Thinking About Going Out-of-Network? Larger reimbursements are yours for the taking, but at what costs? W ith tales of $80,000 knee arthroscopies and $40,000 gallbladder removals, out-of-network billing has a less-than-stel- lar reputation. But some say it represents an opportunity for many sur- gery centers and hospitals to improve profitability. "You can generate higher — and frequently much higher — payments by being out-of-network," says John Bartos, CEO of Collect Rx, a company that maximizes reim- bursements on out-of-network bills. Volume-discount relationship Network providers have agreed to accept the negotiated health-plan price as payment in full. Mr. Bartos says that being in-network works as a "volume-discount relationship," where insurance companies refer patients to providers in exchange for a contract with low reimburse- ments. For smaller centers and individual providers, companies usually hold the power over these contracts, he says. "One of the issues that we came across was that insurance compa- C O D I N G & B I L L I N G Kendal Gapinski z OUT-OF-NETWORK Douglas Won, MD, speaks to a patient at his facility in Dallas, Texas. Dr. Won is an out-of-network provider. In-Network Out-of-Network Patient's insurance 90% of in-network costs 70% of out-of-network costs Contracted fee $2,000 for knee arthroscopy $6,000 for knee arthroscopy Reimbursement $1,800 (90% of $2,000) $4,200 (70% of $6,000) How Out-of-Network Works

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