House Bill 116 went into effect January 1, 2022. This bill has provisions that directly affect the billing practices of providers who assist in surgery. The language in the bill prohibits all practitioners providing surgical assistant services, REGARDLESS OF PROFESSIONAL DESIGNATION (MD, DO, PA-C, CNP, CRNFA, CSA, CFA, SA-C) from billing a patient more than the amount allowed by the insurer while enrolled in an ERISA governed health plan. All ancillary providers are also prohibited from entering into Advance Consent Agreements with a patient. Further, insurance carriers are only obligated to reimburse at the average of their contracted rates.
Del Sol Administrative Solutions, LLC (DSAS) has been created to bridge the gap between multiple hospitals/hospital systems and the surgical-assistant community. DSAS provides a unique operating model providing one point of contact between hospitals/hospital systems-and the independent, small and large group providers within the existing Surgical Assistant market. This relationship ensures that past services provided to your surgeons and facilities remains sustainable.
• Maintain contracts between DSAS and Hospitals/Hospital Systems providing managerial support to the surgical-assistant community.
• Maintain sub-contracts between DSAS and the surgical-assistant community. Include independent, small, and large-group practices, supporting managerial services so that surgical assistants continue to function in your facilities.
• Harvest invoices for these services from across the assistant community, and after auditing, submit a single “clean” claim to the respective Hospitals/Hospital Systems at an agreed upon rate.
• Compensate the surgical assistant community, eliminating the need for Hospitals/Hospital systems to maintain multiple contracts with multiple providers at multiple facilities.
Estimated time of completion from first contact is two weeks. Once contact is made with DSAS, and it is determined that you are eligible to participate, we will forward you a non-disclosure agreement (NDA). Once this is signed and returned, a contract will be forwarded to you for your review. This is not an employment contract, it is a contract of obligations and rules for usage of services. If you decide you would like to contract with DSAS, return the completed contract, and we will begin the on boarding process. Of course, we will be happy to answer any questions you may have along the way. You are under absolutely no obligation to contract with DSAS, and your decision to participate will have no effect on your hospital privileges.
Language in the law expressly prohibits the use of Advance Consent Agreements by ancillary providers. The law also sets forth a uniform Advanced Consent Agreement that must be used by any provider seeking advanced consent, and the form may not be edited in any way.
Current assistant surgeon fee schedules do not support the actual costs associated with providing these services. While in-network rates may be sufficient to support the actual “surgical assistant” services alone, they do not provide reimbursement sufficient to meet the managerial/logistical costs to provide these services. Expenses incurred by an assistant for costs associated with transportation, cancellations, turnover times, billing, scheduling, insurance and credentialing must also be compensated.
Data derived from existing numbers, has given us compensation amounts that comply with fair market value of administrative services being provided. Upon completion of an NDA with Del Sol, we will be happy to discuss rates of reimbursement.
No, these are management costs that remain the same regardless of provider or Specialty type.
No, these are management costs that remain the same regardless of insurance. Del Sol does not process insurance claims, that would be solely the responsibility of the provider or group.
No, only surgical cases identified by CMS’s Physician fee schedule as Assistant-at-Surgery Allowable will be eligible.
No. The existing “Surgical Assistant” market that has operated almost seamlessly up until this point will remain completely intact. DSAS is solely providing a conduit for these businesses and individuals to interact with the hospital systems and vice versa. This will allow the hospital to share in the cost of unreimbursed management costs that would otherwise be borne by the hospital if these providers were employed.
If an assistant chooses to participate, DSAS will contract with the assistant at an agreed upon rate. The assistant will submit the information required to identify the patient, DOS, facility, and surgeon through a HIPAA compliant portal. DSAS will then independently audit room-in to room-out time and formulate an invoice which will be consolidated with other invoices.
No. We are providing management support for assistants that are working independent of surgeon or facility employment agreements. Any assistant performing work at one of your facilities outside of these arrangements, will be allowed to participate. If there is a situation where an employed assistant would like to moonlight, we would require a waiver from the employer and hospital/facility to participate.
You can use the Contact Us form below to send an inquiry or you can email info@delsolas.com.
Arizona General Hospital-Mesa
Arizona Spine and Joint Hospital
Arizona Specialty Hospital
Banner Health
Banner Medical Group
Banner Medical Group contract covers any work provided to a Banner Employed Surgeon at the following Facilities (Surgeon List available upon request)
Banner University Medical Group
Banner University Medical Group contract covers the following with any Banner University Medical Group Employed Surgeon (Surgeon List available upon request)
Dignity
Honor Health
Ortho Direct/Ortho Arizona
Ortho Direct is a bundled payment product managed by Ortho Arizona.
SurgCenter of Greater Phoenix
*DSAS is currently under negotiation with other hospital systems throughout the valley and will update the website when new contracts become available
House Bill 116 goes into effect January 1, 2022. This bill has provisions that directly affect the billing practices of providers who assist in surgery. The language in the bill prohibits all practitioners providing surgical assistant services, REGARDLESS OF PROFESSIONAL DESIGNATION (MD, DO, PA-C, NP-C, CRNFA, CSA, CFA, SA-C) from billing a patient or entering into advance consent agreements with a patient in order to bill them. Further, insurance carriers are only obligated to reimburse at the average contracted rates. Contracted rates for assistant services are a fraction of what it costs to provide the service. The effect of this will be a significant reduction in the ability of surgical assistants to provide these services in your facilities.
Del Sol Administrative Solutions, LLC (DSAS) has been created to bridge the gap between multiple hospitals/hospital systems and the surgical-assistant community in grave need of managerial support. DSAS provides a new operating model providing one point of contact between hospitals/hospital systems-and the independent, small and large group provider Surgical Assistant market. This relationship ensures that past services provided to your surgeons and facilities remains sustainable. Of further benefit, facilities and surgeons working with chosen assistants for years, may continue such relationships with continuing familiarity, efficiency, and overall cost savings.
The current assistant surgeon fee schedules do not support the costs associated with providing the services. While in-network rates may be sufficient to support the actual “surgical assistant” services alone, they do not provide reimbursement sufficient to meet the managerial/logistical costs to provide these services. Expenses such as transportation, cancellations, billing, scheduling, credentialing, training, on-call pay, etcetera must also be compensated.
We pulled historical data to extract average case times over all services and specialties from thousands of cases. We then projected providers’ earning power in other markets given their education, skills and experience. In addition, we extracted an average case load per annum, and looked at the deficit between what contracted rates would have paid over that time period, and any remaining deficit. Assuming contracted rates pay the cost to actually “assist” in the case, the remaining deficit represents the managerial/logistical expenses elaborated above.
No, these are management costs that remain the same regardless of provider type.
No, only surgical cases identified by CMS’s Physician fee schedule as Assistant-at-Surgery Allowable will be eligible.
One of the main obstacles to employing in-house surgical assistants is effectively managing the resource. Forecasting when a facility may need multiple assistants at any given time, or no assistants whatsoever is extremely difficult and unpredictable. Utilizing outside resources to manage this need can provide significant cost savings while meeting the needs of your surgeons.
Simply fill out the contact form below, and a Del Sol contracting specialist will be happy to answer any questions you may have.
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