There have been critical changes in the national Ambulatory Surgical Centre (ASC) marketplace. Over the last decade we have witnessed many independent, and physician owned ASC’s coming up. This is a trending shift from the traditional business model that was followed prior.

The new ASC reimbursement trends according to experts shall have positive impact on the overall business model. Right from medical billing and coding to collection and patient-physician relationship, everything is undergoing changes.  

There are currently more than 5,500 ASCs across the nation, all in communities where the most dynamic providers are partnered with an unsupported or hospital based ASC. Because of these variables, development of same store volume and income increment has moderated in many markets since enlisting new providers has been significantly harder.

Those in the ASC business have hoped to add cases to existing centre’s or revamp ASCs with new administration specialties. These specialties have been cantered on new techniques being used by existing and new providers coming due innovation in technology, added procedures by Medicare and commercial suppliers. This last factor has been powered by various ASCs being purchased by hospitals, so they can exploit the higher reimbursement offered to HOPD ASCs.

In the present day environment, the ASC industry has matured. It is still growing, but there is an increasing amount of mergers and acquisitions taking place, as the market consolidates, in anticipation of regulatory changes. 

Here are four key trends as they evaluate their best move in this industry segment:

  1. Regulation is shortchanging ASCs, but that may change

If you remember, Medicare reimbursement rates used to reimburse ASCs at 86% of fees paid to HOPDs.  Presently, ASCs receive 49% of what Medicare pays for a comparable procedure done at an HOPD.

But, ASCs stand to benefit from continued efforts to migrate care to more affordable venues—a trend that will hold true regardless of whether Obamacare remains in place or is replaced by another system.

Pay attention to the ASC Quality and Access Act of 2017, which was introduced in the U.S. House of Representatives on March 30, 2017. 

The bill introduced a series of altercation including changing the rate of price rises, which would achieve greater reimbursement parity between ASCs and HOPDs.

  1. Transformation is driving various payment methods.

Government reform has raised the importance of revenue cycle management because increased regulation usually means it's more complicated to get paid.  Increasingly, the best run ASCs are those that systematically negotiate rates with payers to ensure they are appropriate.

As healthcare continues to move away from the traditional fee-for-service model, savvy ASCs operators must understand the alternatives such as bundled payments, capitation, clinical integration, and shared savings. ASCs may also want to make additional technology investments.

Another important transformation is the way your ASC medical billing and coding is conducted. Specialty billing is the latest trend, and it would be great if facilities line up resources for this.

  1. ASCs are being pushed to walls to manage rising costs

As noted above, ASCs collect less than HOPDs.  To make matters even more challenging for ASCs, the way they are reimbursed is changing.  That not only means less revenue, it means less profitability unless expenses are well managed.

ASCs must pay careful attention to all expenses, especially those related to HR and supplies.  Practice managers must assess staffing levels to ensure they are adequate given volume levels and optimize scheduling to ensure proper utilization of the surgicenter.

  1. Patients and providers want one-stop shopping

One final trend is theneed and wants for a one stop shop for patients and healthcare providers.

On the patient side, experts have noted the increasing demands that consumers are making on the healthcare system.  Patients want care that is affordable, competent, and convenient.  This healthcare-on-demand preference is seen in the rise of urgent care centers, retail clinics, and ASCs, among others.

To address this need, an increasing number of ASCs are recruiting other specialties with surgical cases, such as gynecology and orthopedics, creating and exploring the one-stop-shopping model.

If this trend is utilized we in future can see a combination of ASC services. Combination such as physical therapy and podiatry practices together or ophthalmology and otolaryngology, plus your medical billing is clubbed with payment posting in one ASC center.

Published By - Medical Billers and Coders
Published Date - Mar-13-2018 Back

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