About the Client

Mississippi Urology Outpatient Surgery Center, LLC is a physician-owned, independent urology surgery center in Jackson, Mississippi, and one of the only dedicated urology ASCs in its service area, drawing patients from across the state.Seven board-certified urologists provide care, supported by an affiliation with a teaching hospital, with short wait times relative to many specialty providers.

Client Need

• Four of five commercial payors paying below 100% of CMS, the highest at 107%
• Ongoing growth and expansion, including additional clinics planned over the next one to two years
• Rising operating, staffing, and supply costs affecting profitability
• A limited market in which patients travel several hours for specialty care

Reimbursement had not been updated in years and sat below market. The largest commercial payor had not issued a meaningful rate update since 2016.

PayrHealth's Solution

PayrHealth managed payor contracting for the surgery center and its clinic together:

Market benchmarking to parity. Benchmarked current reimbursement against market data and negotiated to parity with comparable providers.

Custom reimbursement schedules. Designed fee schedules driven by the center’s top billed codes rather than requesting increases on services it does not perform.

Coordinated clinic and ASC strategy. Held a separate SOW with the affiliated clinic soboth entities reached market parity together.

Key Takeaway:

Rates that had gone years without a meaningful update were brought to market parity through benchmarking and code-level feeschedule design, with the surgery center and its clinic negotiated together.