With CMS finalized rule for OPPS/ASC payment system, ASCs are in a position to be extremely successful in the year 2021. ASCs ability to expand offered procedures, increased reimbursement for ASCs, increased consumer demand, and migrating care delivery are all weighing in favor of ASCs. 

We have summarized seven trends increasing ASCs revenue in the year 2021:

1. Increasing reimbursement: 

CMS will update ASC payments from 2019 through 2023 using the hospital market basket instead of the index previously used to determine payments. The change means average reimbursement for ASCs is expected to increase 2.6 percent.

2. Expanding procedures: 

ASCs can now provide 140 new device-intensive procedures for Medicare beneficiaries because of CMS' decision to lower the device-intensive procedure threshold. A change in CMS' definition of ‘surgery’ also added a dozen cardiac catheterization services to the approved procedure list.

3. Migrating care delivery:

Procedures are shifting from hospitals to ASCs because of CMS' payment updates, as well as the increasing acuity of procedures that surgery center physicians are able to perform. Medical devices are facilitating the migration by creating robotic technology well-suited for ASCs.

4. Continuing transactions: 

Hospitals and health systems are acquiring or partnering with ASCs, while management companies such as Nashville, Tenn.-based AmSurg and Addison, Texas-based United Surgical Partners International pursue additional partnerships and build centers. More than 40 percent of hospitals and health systems own or are affiliated with a freestanding ASC, according to a 2018 survey of health leaders.

5. Mounting financial complexity: 

Although ASCs are paid less than hospital outpatient departments, the amount ASCs spend on human resources, technology, capital equipment and cybersecurity is rising. To maintain profitability, ASC managers are carefully watching expenses, optimizing scheduling and continuously seeking savings opportunities.

6. Introducing alternative payment models: 

ASCs are investing in technology and services to implement alternative models, such as bundled payment, capitation, clinical integration and shared-savings models.

7. Growing consumer demand: 

Surgery centers are increasingly adding ancillary services such as imaging, pathology and physical therapy to attract patients who want convenient, affordable and quality care.


ASCs RCM Challenges

However, despite being set for great success, it’s always critical to make sure you have your eye on your revenue cycle management. While managing your revenue cycle, closely monitoring KPIs such as days to the bill, days to pay, and claims denials; becomes crucial. Beyond simply monitoring them, it’s essential to know some of the common challenges that may be hurting you and the solutions that can help you improve your bottom line. 

Here’s a closer look at two major challenges for ASC’s revenue cycle management:

1. Reducing Number of Denied Claims

Government and private payers are trying to contain their costs by using utilization strategies like increasing or changing requirements for pre-authorization. While most ASCs never see a 100% clean claim rate, it’s not impossible to see rates in the high 90s if you work hard at it. Reducing claims denials offers an excellent way to improve revenue cycle management.

Check on staff members to ensure they’re following appropriate procedures to prevent claims denials in the first place and track performance in how claims denials are handled. Team members need to be educated on how to deal with denials and handle appeals so everyone’s on the same page, and you can work as a team to turn denials into payments.

2. Delayed Payment

When you’re working to improve revenue cycle management, one of the big problems you may encounter is the length of time it takes you to actually bill services provided. Every day it takes to get bills out is costing your practice money and disrupting your revenue cycle. Length of time that it takes providers to dictate patient notes. If your providers aren’t providing same-day dictation, it costs you time.

You need to communicate all providers to offer same-day dictation after surgical procedures and have a policy in place that penalizes those who don’t provide timely dictation. Develop efficient ways that office staff can request amendments on operative notes or coding questions to providers to ensure a timely response. Track missing documentation carefully to ensure you can provide timely responses at the requests of payers.

As mentioned earlier, most ASCs never see a 100% clean claim rate, even for keeping clean claim rate near to 90%, takes lots of efforts. Preventing and addressing claims denials in-house can become overwhelming for ASCs, especially when denials claim more time from staff, which can hurt the overall bottom line.

When it comes to providing medical billing and coding services for ASCs, Medical Billers and Coders (MBC) is one of the reliable and leading service providers across the country.

We are committed to helping ASC stay in full compliance while reducing denials and increasing revenue. To know more about our ASC billing services you can contact us at 888-357-3226/

Published By - Medical Billers and Coders
Published Date - Feb-03-2021 Back

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