In this case, Maria and her team of researchers can investigate transparently or in stealth to learn why there’s an obstacle. Start with a call to explain what’s happening as you understand it. Maybe you simply don’t stand out adequately to remember to steer cases to you. That can be remedied with a special tactical approach and relationship building with case managers and referral partners. If you don’t have time to initiate the remediation, Maria can lend a hand in the interim to get things off to a solid start.

In a situation where price is the only obstacle, Maria and her team work backwards from the margins you want to earn and determine if there’s another way to contain costs internally, reduce waste, or work more efficiently. But sometimes, payers simply won’t budge. 

Is the deal wrong for you? Should they be told “farewell”? Maria will analyze their book of business, competitive and comparative alternatives, payment integrity habits, hassle factors, and tell you straight away if you should fight or terminate. If terminate is the decision, she’ll guide you how to approach the employers involved in that contract directly to fill any gaps. These days, locked out off the directory doesn’t mean locked out of the opportunity. There’s more than one way in if you know what to say and what to offer and to whom. Maria has the list of contacts for whom to call and what to say when they answer. The approach will take a few extra hours per contract but the rewards can more than triple the revenue opportunities – and the option to thumb your nose at the payer who said “no”. Maria can also find ways to save you money, time and effort on billing and collections overheads so that lower prices still deliver the margins without dealing through middle layers of TPAs, PPOs, HMOs and new payor models. 

Maria doesn’t believe in reference based pricing and has successfully told payers approaching her clients to “ease on down the road”. This approach of drawing a virtual line in the sand and declaring that you’ll be paid what the buyer wants to pay for services is pure nonsense…a fad…a race to the bottom…especially now that healthy patients needing total knee replacements and total hip replacements can be operated on in the outpatient setting along with many other cases. On what price will they base payment for cases no longer done in the hospital? Let them offer those silly proposals to your worst competitors or the hospital and see how that works out for them. You don’t owe any payer a discount that isn’t mutually beneficial. Your ASC is about to get so much busier in coming months. Why tie up your most precious option to make revenue with low paying cases from payers who show no respect for your quality, access and value? Let them go negotiate their RBP rates with your commodity-categorized competitor. 

What about health sharing ministry plans?

After a few years dealing with these unregulated revenue management nightmares, Maria knows what to do so you can get paid. 

Is your ASC the bank? or the Surgery Center? The majority of these plans are located in “Loophole Valley”. For ASCs, these plans frequently leave both their member who paid good money into the loophole plan and your ASC waiting to get paid. On occasion, you may get some money but you’ll likely spend countless additional hours and labor reconciling the accounts and chasing the remaining balances of partial payments without EOBs, unmatchable ACH payments without reference information, and long waits to get to zero account balances. Maria looks back at past accounts if you have them, what it took to get paid and then helps you price accordingly so that rates come out “budget neutral” for your ASC or you decline to do business with them and work directly with the patient and an interest free lender. When the sharing plan reimburses the patient, the patient can pay back the interest free lender. Meanwhile, you get paid up front at a fair price. After all, anything over four payments categorizes your ASC as an unauthorized lender – and that’s not allowed by banking rules and regulations. You worry about quality and safety and direct patient care. Set your prices at a fair, transparent and reasonable rate and leave financing to insurers and banks.