4 Key Components in Understanding Your Payer Mix

Payer Mix, or more simply put, the type of insurances your patients have, has a direct impact on your practices bottom line.

However, it is also one of the items many ASC’s struggles to optimize.

Regardless of a practice’s network status, payer mix can fluctuate and cause devastating results. Knowing exactly which payers are optimal for your practice can vary by plan, and should be reviewed monthly on these four key components:

1. Reimbursement Rate

How much of every dollar billed is coming back to you by plan? Starting here is a great way to narrow down the types of plans your practice may want to target servicing in your facility, and possibly more importantly which plans no longer make sense to service in your ASC.

2. Reimbursement Timeframe

Does the payer take days or even years to pay you? Although knowing your collections will come is good, knowing when they will come allows a practice to more accurately gauge their strategic financial plans.

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3. Patient Population

Although a payer may pay well, does your geographic location have patients with these plans? Are the physicians who work at your facility able to bring those patients to you? Deciding to market to a market that simply does not exist is both time consuming and financially wasteful. Knowing that there is a population out there and that there is an ability to bring them to your practice helps determine where to spend those hard-earned marketing dollars.

4. Patient Cost Sharing

No matter how good a plan may be, high patient cost sharing plans can put an added strain on the practices financials as patient balances are more difficult and costly to collect. Strong upfront collections can curb some of the strain these plans put on a practice, but also can have negative impacts on patient retention depending on the collection methods used.

Making Changes…

To summarize, gathering and making sense of all of this data can be a struggle especially if you have limited access to your billing system or antiquated reporting.

However, having this information is essential to making sound business decisions that have the potential to directly improve your bottom line.

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