As per CMS, Ambulatory Surgical Centers (ASCs) are different entities that exclusively provide surgical services to patients who do not require hospitalization and where the duration of services does not exceed 24 hours following admission. This definition applies to ASCs regardless of who the payer is. According to the HHS, Office of Inspector General (OIG), Medicare sets minimum health and safety requirements for ASCs through the conditions for coverage and CMS requires that ASCs become Medicare certified to show they meet these conditions. Over time, many ASCs have taken the Out-of-Network(OON) route; however, increasing price pressures and decreasing reimbursements mean that ASCs must think carefully and then decide the best route for their business.

This session will discover top trends ASC (Ambulatory Surgical Center) facilities are facing with contracting with Medicare and third-party payers. Participants will learn to weigh the pros and cons of contracting, in order to decide whether out of network billing is the best route for your business. The expert speaker Stephanie Thomas will also give you tips and tricks which will help you ensure that your negotiations are successful.

Session Objectives:

Participants will be able to:

  • understand the importance of risk and cost to payers during the contracting process
  • understand what payers look for, and how to effectively communicate with them
  • tips and tricks for billing out of network and why this may be the best option for your bottom line
  • learn how to read contracts and understand what your rights are for renewals
  • feel confident when making a submission for a new contract
  • know the length of time to expect for contracting
  • what data is important to submit with your request
  • understand specific contract terms to watch for
  • know how to prove value to the payer
  • know how to negotiate “carve-outs”
  • know how to terminate a contract

Session Agenda:

  • Myths about Out of Network(OON)
  • Medicare contracting
    • Mandatory documentation to be included
  • Medicaid contracting
  • Blue Cross contracting
  • Triwest or Tricare plans
    • Difference between TRICARE-certified and TRICARE-contracted
  • Commercial payers
  • Narrow networks
    • Contract verbiage for narrow networks
    • Impact of narrow networks on your bottom line
  • What to include with your initial application
  • How to prepare your negotiations
  • How to negotiate carve-outs
  • Warning signs for contracts
  • Pros and cons of out-of-network billing
  • How to terminate a contract

Suggested Attendees:

  • Office Managers
  • Administrators
  • ASC Owners
  • Credentialing Manager or Specialists
  • Billing Manager
  • Physician
  • Healthcare Staff

About the Presenter:

Stephanie Thomas, CPC, CANPC is the Billing Director for CE Medical Group, a third party billing and consulting firm. She has been in the medical field for 20 years. She has experience in multiple specialties of medical billing and coding and is a certified Pain and Anesthesia Coder as well as an Certified Professional Coder. Billing is her passion, which is why she’s efficient at maximizing reimbursements while educating providers and staff on proper coding techniques. She motivates and coaches our billers to ensure they achieve high level of standards.  If Stephanie is out of the office, she’s most likely in the cheering section at her sons’ baseball games.

After Registration

You will receive an email with login information and handouts (presentation slides) that you can print and share to all participants at your location.

System Requirement

Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?
No problem. You can get access to On-Demand webinar. Use it as a training tool at your convenience.

For more information you can reach out to below contact:
Toll-Free No: 1-302-444-0162