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Is Your Facility Raising Fees in 2021?

Jan 27, 2021 | Posted by Jessica Robertson in ASC Billing & Coding

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It’s a busy time of year in an Ambulatory Surgery Center. Cases may have slowed a bit following the end of year rush, but there’s no shortage of things to do. Your task list is likely full of things like: finalizing 2020 figures, preparing for a board meeting, following up on claims from the December rush and even preparing for an audit. Amidst the many items on your January “to do” list, we want to remind you to spend some time reviewing your center’s fees.  Do you plan to raise your fees in 2021? 

We’ve been discussing the topic with our facilities and, so far, have found our clients are raising their fees by an average of 2.25% with a range of 0-6%. However, fee increases are far from a one-size-fits-all model. Here are a few things to consider when reviewing your fee schedule for the coming year.

  • Does your current fee schedule allow your facility to maximize payer contracts?  This may seem obvious, but we have seen several instances where a facility’s allowable on a contract exceed their fee for the service. Don’t leave money on the table!
  • Does your current fee schedule allow your facility to maintain a healthy profit margin?  When you’re reviewing the profitability of a case, be sure your calculations are inclusive of both direct and indirect costs. (For example: facility overhead, personnel expense, implants/hardware, PPE, etc.)
  • Is your current fee schedule competitive with other ASC’s in the area?  Keeping competitive pricing is attractive from a marketing perspective, but also from a compliance perspective to ensure fees are customary and reasonable. ASCA has some great benchmarking statics which you may find helpful in this research.
  • Do any of your payer contracts pose a limit on fee increases?  Some payer contracts impose a limit on the amount by which a facility can raise their fees in a given year. Be sure to check your contracts for such limits prior to suggesting any changes.
  • Is your fee schedule compliant?  Always of the upmost importance is ensuring your fee schedule is compliant to national, state and local laws. Be sure to submit any changes for review by your facility’s governing body prior to enacting any changes. And finally, should changes be approved be sure to keep specific documentation as to which fees were changed and what justification was used for the change.

If you are drowning in “to do” list items, or could use some help strategizing for 2021 we’re here to help! Drop us a note in the comment section below or give us a call at 855-208-5566.

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