The year 2017 is shaping up sensing an interesting year, with full of opportunities which includes ASC- Ambulatory Surgery Center. The Trump administration which is taking over the healthcare and looking to push new healthcare act which will promote Trumps healthcare ideas.
One potential change could be the easing of restrictions that will encourage carriers to sell insurance across state lines. This could help ASCs located close to state borders to negotiate contracts with new payers. It would also likely lead to increased competition between payers, which may help give ASCs some contract negotiating leverage.
Even if the ACA is repealed, what is not likely to go away any time soon is the patient responsibility for a large portion of services provided. ASCs must have processes in place to secure co-pays and deductibles from patients. Failure to do so could make what should be a money-making procedure into an unprofitable one.
The trends and development to watch out for ASC Revenue Cycle are:
#1.There will be increased migration procedure
Procedures are increasingly leaving the inpatient setting for lower-cost, higher-quality settings, such as ASCs. This will continue in 2017; although total joint replacements, pain management and spine surgeries are at the forefront of this movement, procedures in other specialties are being considered for approval to be performed as outpatient, such as vascular surgery and cardiology.
ASCs are well-positioned to capture this volume, but an effective ASC billing and coding will be necessary which ensures they collect what is rightfully owed to them as they add and perform these new procedures.
#2. More device intense procedures
Some of the more complex procedures migrating to the outpatient setting, such as in orthopedics and spine, require the use of implants, and usually expensive ones. If ASC billing is planning to add these types of procedures, they will need effective strategies for purchasing implants at a reasonable cost and negotiating their coverage by payers.
Reimbursement for device-intensive procedures often includes the cost of the implant. ASC medical billing companies must be aware of what their contracts allow for these procedures as they can vary greatly from payer to payer.
#3. Focusing on bundled payments
Reimbursements are gradually shifting from reimbursement based to fee-for-service toward pay-for-performance as part of value-based care. Another payment method receiving most attention is bundled payments.
It has already been implemented by CMS and some private ASC medical billers, resulting in lower reimbursement rates for hospitals in some specialties. The intent is to continue this process until all hospital reimbursement is based on this model. Eventually, it is expected that this will trickle down to HOPDs and ASC joint ventures as well.
#4. Health plan mergers
Two major potential mergers are presently in limbo: Aetna/Humana and Anthem/Cigna. As CFO recently noted, a court ruling on the Department of Justice's challenge to these mergers can be expected soon. ASCs medical billing will want to pay attention to the outcome as it may set the tone for more or fewer of such mergers during the year.
#5. Reduced frauds
Combating fraud continues to be a high a priority for the USA government in 2017, which is why ASCs medical billers must ensure they comply with proper coding and billing requirements or face serious penalties.
This is true regardless of whether these business office functions are performed in-house or outsourced. If one chooses for outsourced ASC medical billing and/or coding, it will want to verify that its revenue cycle management partner uses experienced and certified ASC billers and coders, ASC-specific software and that they have a written and active compliance plan in place. Even unintentional coding and billing mistakes can lead to fraud charges.
Bottom Line
What will this mean for ASC industry? That time will only tell, but it will not be surprising to see other health plans becoming more aggressive in their efforts to acquire ASC management and development companies as well as individual ASCs.
It will be interesting to see what position these health plans take when negotiating contracts with ASCs they do not own, particularly those that share markets with ASCs they do own.
