Ask Caryl: Selecting MCOs for a New ASC

Q: Our surgery center will be opening in a few months. Do you have any recommendations as to which managed care organizations (MCOs) we should choose?

Caryl Serbin: Contract negotiations are a lengthy business, so getting started early is a good idea. I have found the following tips help in making the best selections:

1. Determine financial stability of lesser-known plans by checking with your state insurance commissioner.

2. Get information about the potential plan, including:

  • market share;
  • history in your market;
  • types of products (PPO, HMO, POS); and
  • breakdown of members by type.

3. List the plans in order of those with the largest number of contract holders in your area.

4. Choose the plans that make up large patient volumes for your referring physicians.

5. Don't create a "loss leader" to attract physicians. Just because a company is popular with your providers doesn’t mean it will pay your ASC fairly. Attracting quantities of patients from a carrier that doesn’t cover your costs is not your ASC’s goal. The goal is to receive a fair reimbursement for your services.

6. Choose well-known plans to begin your negotiations (e.g., Blue Cross, Aetna, UHC).

7. Select PPOs that steer members to your facility in return for a discounted price.

8. Specifics to look for in choosing a PPO:

  • Has a current provider directory
  • Provides a list of payers
  • Members have ID cards with a number to verify eligibility
  • Requires credentialing of providers
  • Has set fee schedule

Have an ASC revenue cycle question? Ask Caryl by emailing caryl@serbinmedicalbilling.com or fill out the form at the top of this page.

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