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A P R I L 2 0 1 5 | O U T P AT 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
What to do next
If you're thinking of going out-of-network, here are a few things you
can do to make the transition easier:
• Determine prices. Look at your local market's average fees, which
can be done on databases such as Fair Health, and set your prices in
the mid-to-higher end to maximize profitability, says Mr. Bartos. Be
sure, he says, that prices are justifiable. Also, tell patients that it's
possible that an in-network surgeon could perform their procedure,
but that the anesthesiologist or radiologist could be out-of-network.
• Billing: in-house or third party? Whoever does your billing needs to
have the expertise and resources, says Mr. Bartos. If using a third party,
the company should work on a contingency basis, so the more money
you earn, the more they earn. Dr. Won, who uses Collect Rx, says he
found that using an outside company has saved money and time.
• Start slow. Pick a payor that only has a few patients who come to
your center, terminate the contract and see how you do, suggests Mr.
Bartos. Dr. Won says to be sure that when you terminate the contract it's
"well-documented" and to "notify everyone that needs to be notified."
• Find what works. Look at the local payor and employer mix, compara-
ble reimbursement levels for common procedures and the relative mar-
ket share of your center compared to others, says Mr. Bartos. This can
be done in-house or by an outside consultant, but it will help you deter-
mine which payors are worth contracting with and which ones aren't.
• Talk to a lawyer. While being out-of-network can be lucrative, there
are legal risks, especially when it comes to how you handle patient
payments, physician-ownership of the ASC and your fees, says Mr.
Manigan. Laws vary among states, so talk to an attorney before
adding out-of-network billing. OSM
Ms. Gapinski (kgapinski@outpatientsurgery.net) is an associate editor of Outpatient Surgery.
