5 Things to know about ASC Payment and Policy Changes

June 02, 2016

5 things to know about ASC payment and policy changes

The most essential area where the performance of Ambulatory Surgical Center matter the most is not just the type of procedures undertaken and the healing services provided. Today an ASC facility has become more document oriented, where right from the medical billing and coding tasks, to payment and policy changes have to be updated and adhered with.

Here are five key things one should understand regarding the current year’s ASC reimbursement and policy changes.

  1. ASC payments are upgraded on a yearly premise in view of the Consumer Price Index for every single urban purchaser. For CY 2016, CMS has proposed a 1.7 percent CPI-U upgrade. With a multi-component profitability alteration of 0.6 percent, the redesign is relied upon to be 1.1 percent. CMS has also put forth the expulsion of radiation treatment utilizing Co-60 stereotactic radiosurgery from the list of ASC covered services.
  2. CMS has not proposed any new measures for the ASC Quality Reporting Program, whereas the CY 2018 ASCQR Program incorporates 12 measures; 11 required and one intentional.
  3. CMS proposes to upgrade OPPS rates by -0.1 percent, taking into consideration the hospital market basket increment of 2.7 percent with a -0.6 percent change for multi-element profitability and a -0.2 percent point alteration essential by law. There is an extra - 2 percent point modification for tending to the inflation factor in OPPS installment. Considering all strategy changes, CMS has appraised -0.2 percent conformity for doctor's facilities paid under OPPS in CY 2016.
  4. CMS additionally has planned rebuilding, revamping and merging numerous OPPS Ambulatory Payment Classification groups. This move would bring about less APC for nine clinical APC families. The billing agencies that are home based as also the outsourced medical billing services should remember that there are nine new Comprehensive Ambulatory Payment Classifications projected for CY 2016. There are as of now 25 C-APCs.
  5. CMS hopes that a vital precept of a forthcoming payment framework is related to packaging all the integral, ancillary, supportive, dependent, or adjunctive services into primary services. In CY 2015, CMS restrictively packaged numerous ancillary services. But, for CY 2016, CMS has put forth to restrictively bundle a predetermined number of extra ancillary administrations, specifically certain minor methods and pathology administrations. CMS is additionally offering to package payments for a couple of medications that aid as supplies in a surgical procedure.

Points to Remember:

  • CMS is likewise proposing changes to the laboratory test payment policies. One key proposition is for a new conditional packaging status indicator for lab tests that will make it simpler for hospitals to get separate payment for lab tests that are given without other related OPPS administrations. This would eventually contribute into making an easier billing process.
  • In cases where the policy changes pertaining to ASCs are not yet beneficial according to your personal health plan, then CMS is accepting remarks on the alterations until August 31. Keep in mind the final policy and payment rule for CY16 will get implemented from November 1.

Understanding the gamut of healthcare payment changes for ASCs, it is beneficial to stay well prepared with the appropriate billing process in place that would ensure continuous profitability to the surgical centers and get rid of impeding revenue challenges.


Category : Revenue Cycle Management