Welcome! The ASC 101 Webinar will begin

Transcript:Welcome! The ASC 101 Webinar will begin:
Welcome! The ASC 101 Webinar will begin momentarily. To participate with audio by phone (mute/unmute, press *6): 1. Select the gear icon on the right control panel 2. Select the ‘Phone’ option 3. Be sure to enter your Audio PIN so we can help answer your questions! To participate with audio via your PC (mute/unmute using mic icon): Ensure the right mic/speakers are selected under the ‘Computer’ option. Please mute yourself when you are not speaking. You can also ask questions via the Chat feature: This meeting will be recorded. ASC 101: Managed Care Strategy in the Age of the No Surprises Act ASC Historical Approach to Managed Care Stay out if possible, out of net reimbursement tended to be pretty lucrative. If forced to contract, go for highest rates; use carveouts if necessary. Ensure ASC can see all patients. Ensure all individual procedures are profitable. The Difference Between A Managed Care Strategy and “Go Renegotiate My Anthem Agreement” Managed care strategy is based on understanding several factors: Practice position in the market. Portion of specialty provided locally. Overall cost effectiveness to a provider; at least Medicare cost scoring. Overall payer landscape and that particular payer’s position in the market (both today and in the future). Payer Performance Admin burdens under which the payer forces the provider to operate. Full case denial rates, line item denial rates, underpayment rates, claim turn/days in AR. Changing legal/regulatory landscape (ala No Surprises; CON; DOI/DCH support). Managed Care Strategy vs. Renegotiating Contracts Market Analysis Who are the major payors? Governmental vs. commercial participation Financial Proformas In-network vs. out-of-network reimbursement Understanding your case costs (direct vs indirect) Operational Issues Are there administrative burdens that the ASC needs to solve to see patients? Inability to obtain authorizations Redirection of care concerns Practice Positioning in the Market What portion of the market for our specialty does our practice represent? If we don’t participate (MD side), do we create a real problem for a carrier? Are we growing? Growing significantly? MD and ASC sides? Can we support that we are cost effective? (Medicare data or otherwise) Does the practice or ASC have capacity issues leading to long appointment lead times or other possible customer service issues a payer might know about? Are our payer relationships good? Do they see us as market critical? The Payer Landscape: What Market Forces are Changing All This? Shifting Payer Market in Georgia