![Asc付款人合同网](/Areas/CMS/assets/img/blank.gif)
支付方一直在寻找为雇主集团节省成本的方法, 这导致在与供应商签订的设施合同中包含可以限制的语言, 减少, 拒绝付款. 纳税人 are getting creative and including new types of restrictions and requirements in Ambulatory Surgery Center (ASC) contracts and amendments; for example, they may make changes in their online provider manual or provider update letters that never make it to your desk for review.
It’s more important than ever to read an ASC contract or amendment prior to signing it and again after receiving the finalized version. We recommend highlighting key contract payment terms and language provisions that impact reimbursement for your business office so it may operationalize the contractual obligations and build them into policies and procedures to maximize contract rates and avoid lost revenue.
Juggling the time frames and rules of contracts can be difficult because they may vary greatly from plan to plan and even between products within the same health plan. You should establish a contract methodology tracking mechanism so your staff can keep your ASC business office compliant with the rules and update the claims system appropriately per payer and the various products in each contract. 这还可以帮助您和您的员工识别各种付款人的趋势和问题.
以下是10个重要的管理式医疗合同注意事项,您应该与您的ASC业务办公室一起审查. Create clear policies and assign responsibilities for each so that your business office realizes the value of the ASC’s contracts and collects 100% of the reimbursement that is due from all payers.
1. 及时归档要求
随着电子归档成为常态, payers continue to 减少 the time to submit claims (we’ve seen this time frame as short as five days in ASC contracts) and are setting financial penalties that can include nonpayment of the entire claim. 确保你的办公室知道每个付款人和合同中所有产品的及时归档规则. 在很多情况下, Medicare Advantage’s timely filing limit will be longer than the one for commercial products because Medicare regulates the timely filing limit. 不要假设一个付款人对合同中的每个产品都有相同的及时归档要求.
2. 解决争议的时间框架
确保在你的政策和程序中记录争议索赔和提出上诉的时间表. 时间线通常从收到付款人的付款开始. 在ASC合同中,许多付款人将这个时间框架从bet8娱乐之日或付款之日起缩短到一年或更短.
3. 回收过程和时间框架
概述在超额付款的情况下,您的业务办公室必须向付款人处理退款支票的时间框架. 这因付款人而异. 许多计划只允许一个月或更短的时间,从你的业务办公室被通知退还多付的款项. 如果这笔多付的钱没有退还, 付款人可以抵销未来的付款, 对于业务办公室人员来说,哪些处理可能会耗费时间. Having a process for sending refunds to payers will save your business office the time of posting partial payments in the future.
4. 遵守供应商手册的合同义务,包括电子更新要求
Be sure to have an ASC business office representative responsible for periodically checking the various updates to provider manuals, 以及付款人的通讯和书面更新. This is an important role in the business office to help ensure any changes to payer processes that may have a material change to reimbursement are tracked and then included in your business office’s policies and procedures. 纳税人 are moving away from sending letters and hard-copy notices of changes in fee schedules and policies to making updates via electronic newsletters and website manuals. 大多数付款人合同都提到了供应商在供应商手册中公布的变更方面的责任和义务. 您必须阅读“提供者责任”下的细则.“这意味着ASC有责任, and a business office representative should be accountable for searching the online tools that the payer provides on a periodic basis and abide by any published changes because the ASC must comply in accordance with the contract language.
5. 查阅记录的时间框架
许多付款人在要求asc提供临床或账单记录时需要快速周转时间. 付款人要求提供信息的期限通常包含在付款人的合同条款中. Be sure the ASC business office team is aware of these terms and the timeline that is required to send information to the plans when requested.
6. 按合同要求向付款人披露的信息
Check the contract for any information or updates that you are contractually obligated to send to the payer; this can include changes to the provider roster, 的认证, 所有权, 或ASC的管理. Be aware of any monetary fines associated with not complying with a contractual obligation to update the payer with this information.
7. 错过时间框架的经济处罚
重要的是要审查合同条款,以确定ASC需要多长时间向每个付款人提出索赔. 并非所有的付款人都有相同的及时申报要求,处罚可能会有所不同. 大多数付款人在及时提交期限后收到的索赔正在走向不付款, 许多付款人在新合同中缩短了这个时间框架,所以当你续签合同时,它可能会改变.
8. 对在付款人网络之外的机构bet8网站备用的经济处罚
Many large payers are including contract language that allows the payer to 减少 overall payments for a specific time period or indefinitely if nonparticipating facility-based physicians are utilized by the ASC to provide services. 这包括但不限于麻醉师, 放射科bet8网站备用, 和病理学家, 也被称为“隐藏提供者”.”
9. 付款人方法的不同
全面审查付款方法的逻辑和条款. Some other important questions to answer when conducting a contract review are: How does the payer reimburse for cases with multiple procedures at your ASC? 他们会额外支付植入费用吗? 合同中是否包含了从方法论中分离出来并以不同费率支付的手术代码? 付款人对不同产品的报销方式是否存在差异? 例如, do commercial cases reimburse under a methodology that differs from the reimbursement methodology for the Medicare and Medicaid Advantage plan cases? 每年的税率是否会自动上升, 你如何在你的索赔支付跟踪系统中解释这些更新? 你如何向业务部门传达合同价格? 这些都是您必须与业务办公室人员一起解决和审查的问题,以确保建立标准.
10. 付款人合同重新协商续订日期
如果合同期限是三年, 跟踪合同期限,并与付款人重新协商合同. 要求加薪是很重要的, so plan to contact the payer approximately eight months or more prior to the date that you can exercise termination and/or to the final term of your contract so you have time to renegotiate rates before the start of the next contract term. 付款人不会主动要求你提高费率, and they will normally have language in the contract that allows the last set of rates to continue—it’s up to you to negotiate your ASC contracts!
合同管理与勤勉的重要性
除了在您的ASC提供卓越的临床bet8娱乐, part of being a good steward of your payer relationships is ensuring that your team has knowledge of and the ability to comply with the rules, 规定, 以及不同付款人指定的时间框架. Policy and procedure implementation based on payer expectations and requirements is an important part of contract management. It is a good idea to review your contracts annually to ensure your office is in compliance with all payer contract requirements. Paying attention to these 10 key factors will help your ASC mitigate losses and optimize revenue while remaining in good standing with contracted payers.
2018年9月19日发布