Michael McClain – Opening an ASC: Navigating Payer Contracts
Here’s what to expect on this week’s episode. 🎙️
Last week, we sat down with Wil Schlaff to talk about how to conduct a feasibility assessment for your new surgery center.
As a continuation of that conversation, we’re sitting down with Michael McClain to discuss navigating payer contracts for your new surgery center. Michael is the founder and managing member at LeftCoast Healthcare Advisors, and we are talking through how to initiate payer conversations, positioning yourself to get the best rates, effectively managing contracts, and the complexities to consider along the way.
A few highlights:
⏰ Timely Start for Payer Contracting: Payer contracting discussions should begin six to nine months before an ASC’s opening.
📊 Market Analysis: Research your local market to identify key payers, volume, and potential patients. Patient EOBs can be a valuable resource for determining actual reimbursement amounts.
☎️ Engaging Payers: Reach out to physician representatives and payer market representatives early on. Initiate contact with payer-specific negotiators to discuss rates, terms, and credentialing.
🗣️ Understanding Rate Negotiation: Negotiating rates involves understanding your costs and the value you bring to the payer. Obtain the entire fee schedule from payers to negotiate effectively.
🚫 Termination Provisions: Pay attention to contract terms and termination provisions. Negotiate terms that align with your ASC’s growth plans and allow flexibility.
Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details.
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