ASC physician benchmarking

How does ensuring reimbursement per contract agreement maximize revenue?

After proper code entry and follow up, ensuring that an ASC is being reimbursed the full and correct amount per each contract agreement is one of the most important billing practices to maximize revenue for the center.

Contract knowledge ensures correct reimbursements

It’s imperative that revenue cycle specialists are intimately familiar with every payer contract and have read through every one. Without this knowledge, your center may not be receiving the full reimbursement payment, but no one will know. For example, if the insurance says they’re only paying $1,500.00 but the contract says they should be paying $2,500.00, the ASC is missing out on $1,000.00. And often an insurance company won’t point out if the payment is incorrect. Knowing the amount of each reimbursement per contact allows a center to immediately appeal an underpayment when a discrepancy occurs.

Due diligence is an important aspect of this practice as revenue cycle specialists should take the time to confirm that the reimbursement received matches the contract rate, and if it doesn’t, the payer should be contacted immediately in order to optimize revenue to its fullest potential. Because of this, it can be useful to upload each payer contract into your center’s management information system (MIS) software to easily access information as needed.

Contracts can change or be updated over time

There are changes and updates that can occur as well that revenue cycle specialists should be aware of:

  • After one year, the reimbursement rate in the contract may increase a percentage
  • Some contracts may include a multiple procedure discount with different rates after the first procedure
  • Contracts may have “groupers,” or groups of codes, that can change over time
  • After one year, it may be time to renegotiate the contract

Therefore, ASCs and revenue cycle specialists need to stay on top of any and all changes that occur to maximize revenue and improve the center’s overall financial wellness.

Complete reimbursement audits

To ensure that your center is receiving its full reimbursement per each contract agreement and any repayment issues are being addressed, we would strongly recommend a reimbursement audit as part of a larger business office audit. Based on the results of your audit, underpayments can be appealed and problematic claims can be resubmitted.