Challenges faced by Ambulatory Surgical Centers
- Since the market has matured, competition has increased as more hospitals are purchasing or opening ASCs. In saturated markets, many centers are accepting rates that are well below market level. Payers have started using low rates as a baseline when comparing other ASCs. This has resulted in rates getting undercut for other ASCs as it has become difficult to show payers why they need high fees for covering their expenses
- Low Medicare reimbursement rate is another challenge being faced by ambulatory surgical centers. Even though an overall payment rate adjustment of 1.4% was adopted by the CMS, HOPDs happened to receive a larger increase and this widened the gap between the Medicare payment ASCs and HOPDs get for the same procedure
- According to the ASCA, hospitals get 81% more of Medicare payment than ASCs for performing the same procedure. Due to this disparity, many hospitals have started purchasing surgical centers to convert them into outpatient facilities and charge high outpatient rates
- Many ambulatory surgical centers are unable to perform numerous procedures because the Medicare reimbursement for the device is inadequate
- Due to decreased payment from insurers, it has become difficult to retain and motivate physicians. Bigger health systems are constantly acquiring physicians, resulting in fewer independent surgeons
How are ASCs dealing with revenue issues?
ASCs are struggling with Medicare regulations such as Quality Net Reporting, changes in payment, issues with compounding pharmacies and sequestration reduction. As they are getting reduced payment, it has become necessary for such centers to make improvements in clinical documentation and implement automated coding to get timely payments
Impending ICD-10 has also increased challenges for ASCs. Centres with an in-house billing team are gearing up for ICD-10 by hiring experienced coders and training existing staff for the big change. Some centres are even hiring a financial officer to handle the revenue cycle needs and to monitor the billing department functions.
On the other hand, many centers have started outsourcing their ASC revenue management needs to a third party. They are relying on the expertise of a billing company as far as error-free coding, timely claims submission and AR management is concerned.
From capturing every penny for rendered services and maximizing out-of-net reimbursement to making successful appeals and closing old AR accounts, ASC billing services are helping surgeons run a successful surgery center. Billing companies are also helping ASCs comply with the changing regulations, including HIPAA. Since a dedicated team is assigned to handle the ASC’s RCM needs, surgeons don’t have to worry about coders’ productivity loss, compliance with regulations or follow-ups with insurance companies for payment. The billing company performs these tasks for the surgical center, freeing the surgeons and medical staff for provision of quality care.
