As health insurers encourage more in-network participation from providers, they have ramped up their focus on ambulatory surgery centers that are out of network, according to Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management.
Physicians are the main group targeted in these discussions, she says.
"They are actively pursuing surgeons who practice in non-contracted ASCs and are sending notices to surgeons who use non-contracted ASCs that indicate they are in violation of their professional contracts by directing patients to a non-participating facility," she says. "Some payors are demanding from surgeons copies of the ASCs' out-of-network billing practices, policies and procedures. They are threatening to terminate their professional contracts as a result of taking patients to an out-of-network facility."
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