![]() When reviewing a contract for your ambulatory surgery center to become a participating provider, ensure there is a clause that holds the health plan responsible for paying claims within a specified period of time. To avoid costly delays in payments, be sure to understand your rights when negotiating a contract and request interpretation of the insurance provider's payment schedule language.Ģ. ![]() Most health plan contracts do not contain clear claim payment guidelines, and most avoid language that would hold them responsible for paying a claim promptly or limiting their ability to request unnecessary information to delay payment of the claim. Follow these seven tips to make sure the contract you agree to is in your ambulatory surgery center's interests.ġ. With private payers, your best defense is your contract. Are you aware of your state's prompt-payment regulations? How does your ambulatory surgery center monitor that reimbursement is received in accordance with those guidelines? There are several sources on the internet that will provide state-specific requirements, including this resource from the American Medical Billing Association. Prompt payment statutes are different for each state. Medicare defines a clean claim as one which has no defect, impropriety or special circumstance, including incomplete documentation that delays timely payment.Īre you aware of state and federal prompt-payment laws and their requirements? How do monitor that ambulatory surgery center reimbursement is received in accordance with those guidelines? In this Special Report, we review prompt-payment laws and provide guidance to help your ASC ensure timely receipt of payments. Clean claims must be filed in the timely filing period. Most private payers define a clean claim as one that does not require the payer to investigate or request additional documentation to determine payer's responsibility on a prepayment basis. For fair and timely reimbursement of healthcare claims, it is necessary to understand what constitutes a "clean claim" and the time period in which these claims are to be paid. Payment by government and private health plans for services that are not medically necessary has led to higher premiums and out-of-pocket expenses to the policyholders. While it is imperative that your ambulatory surgery center obtain reimbursement for services rendered within a reasonable amount of time, it is also necessary for third-party payers to have the opportunity to investigate their responsibility in the payment of the claim and determine if the services provided were medically necessary. Most states provide recourse against delaying insurance payments by enacting prompt-payment legislation for private health plans that dictate reimbursement to providers must be within a specified amount of time. ![]() Understanding Third-Party Payer RequirementsĪre your ambulatory surgery center's third-party payers "stalling" when it comes to payments? Nationwide, ASCs and other providers often encounter inconsistent cash flow due to payment delays from insurance companies. ![]()
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