Key Opportunities in out-of-network strategy for ASC

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Key Opportunities in out-of-network strategy for
ASC
The beginning of the Patient Protection and
Affordable Care Act resulted in millions of
Americans becoming insured on plans with
out-of-network benefits. Also, this act has
narrowing insurance networks which left many
providers completely out-of-network. Therefore,
the out-of-network strategy for ASC is only
revenue enhancing strategy for some ASCs.   There
are some key opportunities available with
out-of-network offerings and you will get the
details of opportunities in the following
briefs The rise in overall reimbursement The
changing and sometimes volatile world of
insurance can be stressful for practitioners who
desire a more predictable income stream.
Fortunately, there are some ways exist to improve
your reimbursements and it starts with developing
a good out-of-network strategy combined with the
right expertise. You can avail the best pay-off
by creating a hybrid strategy which includes
out-of-network and in-network strategy. Moreover,
you can enhance revenues by making out-of-network
payments a small part of your surgery center
business.
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Key Opportunities in out-of-network strategy for
ASC
Lastly, the marketplace plays an important role
while implementing a hybrid model to maximize
revenue and you need to determine which payers to
pursue this strategy with based upon
reimbursement levels compared to the levels of
reimbursement if your surgery center was
in-network with that payer. Rising certain
market trends According to a study around 60
billion of out-of-network claims are getting
processed every year and this data is enough to
let you understand the out-of-network strategy
for ASC is a future. Moreover, certain market
trends will boost the opportunities for
out-of-network ASC benefits. For example,
Continuous growing PPO enrollment driving
patients to pursue out-of-network opportunities.
Lastly, people are willing to pay for
out-of-network benefits, and payers continue to
offer them. PPO is a type of health plan that
contracts with medical providers, such as
hospitals and doctors, to create a network of
participating providers. You pay less if you use
providers that belong to the plans network. You
can use doctors, hospitals, and providers outside
of the network for an additional cost.
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Key Opportunities in out-of-network strategy for
ASC
Higher rate of reimbursement compared with
contracted reimbursement rates When it is
out-of-network cases then reimbursement rates are
likely five times as high as contracted
reimbursement rates. Hence even if you only have
a very small percentage of out-of-network cases,
it can make a significant difference in your
surgery centers revenue. This higher rate of
reimbursement can account for a large percentage
of your reimbursements each year, boosting your
bottom line. Maximize your investment Many ASC
is always looking for maximizing their investment
and it can be achieved easily with experts who
are having the right training and experience.
When you try going out-of-network without the
right training and experience, it can be
difficult to succeed, which is why it can be
helpful to outsource your out-of-network billing
to a company like Medical Billers and Coders that
has plenty of experience handling various complex
claims.
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Key Opportunities in out-of-network strategy for
ASC
Finally, payers declining reimbursements make it
impossible for some providers to accept
in-network patients and continue to remain in
business, forcing them to consider an
out-of-network strategy as a means of survival.
In brief, a combination of rising potential
out-of-network ASC patients and reduced payments
mean out-of-network must be a part of a centers
strategy. If you are looking for an
out-of-network strategy for ASC then partnering
with medical billing company like Medical Billers
and Coders will benefit you for claim settlement
and reimbursement as we have demonstrated 95
clean claim submission.