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Payer Contracting

A financially healthy anesthesia department is economically sustained by three sources: insurance reimbursements, patient payments and facility subsidies. From the perspective of patients and facilities, maximizing insurance reimbursements is critical. Only a knowledgeable anesthesia management team with payer-negotiating experience can ensure that deductibles and copayment plans are optimized and patients are not being asked to pay more.

Patient complaints eventually impair surgeon satisfaction and audits, particularly those in front of the backdrop of compliance lapses. In the end, unhappy patients and surgeons, compliance issues or both can oftentimes create more headaches than a higher subsidy. Today, with higher copayments and deductibles, these same issues may occur, even in front an in-network backdrop.

Better Rates. Higher Returns.

Somnia’s in-network philosophy and national footprint deliver the economies of scale that allow us to leverage our size in the negotiation of better rates from payers, albeit without causing durable friction or angst. We are in-network with more than 95% of relevant payers. In a day and age where many anesthesia departments have a very low threshold to remain out of network, we stand apart in our philosophy. As a result, payers have less to negotiate when contracting with facilities. We are able to be creative and innovative with payer-based pay-for-performance initiatives to ensure higher returns. 

We Monitor Payer Contracts

We do our homework, reviewing, revising and amending payer contracts. Prior to engaging in a new partnership, we pursue timely and complete credentialing with major payers, sometimes even retaining consultants to provide perspectives and insights. We monitor credentialing renewals, and we audit contracted verses actual payments. Our strict monitoring of payer contracting is a key element of our end-to-end revenue management.


QUESTIONS? WE HAVE ANSWERS.

To discuss your current and future anesthesia needs with our experienced staff, please call us at 877-795-5788, or use our Request A Proposal form to tell us about your requirements.