Former President Obama signed the new healthcare reform Affordable Care Act (ACA) in 2010 with great support and opposition from Republicans. The Trump administration made the ACA a significant focus during the campaign and even tried to repeal it in 2010 with the new reform. Currently, legislators are considering multiple plans to revise the current act, which will, in turn, affect the ASC medical billing.
Healthcare legislative efforts in pursuing the focus on Medicaid funding and access to affordable insurance plans will affect the ASC’s Revenue cycle. The changes in Medicaid regulations will have a direct impact on ASC reimbursement. High-deductible healthcare plans would disrupt the current patient’s financial responsibility for a large portion of their care. If the current trend continues, we can expect some significant challenges that might come up with highly deductible plans for the patient.
If the new ACA passes, this would mean a great coverage loss for some individuals, which would, in turn, lower patient volume for ASC providers or even higher costs associated with uninsured patients. According to recent data, 83 percent of patients are directly or indirectly (through employees) contributing to medical reimbursement.
Patient contributions toward provider reimbursement have increased, impacting revenue generation. Almost 25 percent of providers’ revenue is now coming through self-pay, resulting in bad debt for ASC facilities across the USA. Currently, more than 15 percent of consumers are failing to pay medical bills, which is disrupting the ASC revenue cycle management.
This has led to providers focusing on patient collection more than other aspects of patient responsibility and estimating the time of service for the patients. Facilities and practices are now collecting the inefficiencies, resulting in progressive cost-cutting to maintain quality and care.
With rising ASC provider costs, providers are now looking for alternative methods for lean and efficient operations as this becomes possible. This leads to a requirement for automation or an outsourced team of medical billers and coders. ASC facilities are now seeking simpler solutions and are adopting legislation to address price transparency for the facility.
ASC Funding Plans
According to data shared by companies with more than 500 employees, we have found that self-funded plans from employers have increased to 82 percent. Due to this, employers are now becoming a part of medical reimbursement and one of the significant parts of ASC billing. “ASC facility is perfect for many employees and employers due to resourcefulness and reduction in time consumption. So, employers are offering better coverage of ASC facilities, and, in turn, employees are seeking ASC facilities for primary care. So, given such a situation, the industry is adopting a new payer class that can be self-funded. ”
The insurance companies are now trying to follow the path of employer groups in adopting the new business model with ASC facilities. Depending on the market, there could be a profitable arrangement for ASC facilities with the employer group taking the area and contracts and implementing the timely payment.
ASC Bundled Payment
Bundled payment is becoming a significant part of the ASC facilities, and service requirements are expanding. With 97 percent of health plans from employers, fee-for-service and value-based reimbursement for ASC facilities have been added. ASCs are responsible for bundled payments to understand payer contracts and ensure the bundled rates won’t hurt the ASC facility. The ASC service provider is now seeking a mix of fee-for-service and value-based care for reimbursement.
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FAQs
1. How has the Affordable Care Act (ACA) impacted ASC billing in Texas?
- The ACA has significantly influenced ASC billing in Texas by introducing regulations around Medicaid funding and affordable insurance, which affect ASC revenue cycles. Proposed changes to the ACA could further impact patient volume and reimbursement rates.
2. What challenges do high-deductible healthcare plans pose for ASCs in Texas?
- High-deductible plans mean Texas patients face more out-of-pocket costs, which can lead to payment delays or non-payment. This increases the financial burden on ASCs and affects their revenue cycle.
3. How are ASC facilities in Texas managing revenue cycle challenges due to patient non-payment?
- Texas ASCs are focusing on patient collections at the time of service, cutting costs, and considering outsourcing billing functions to improve revenue cycle management and reduce the impact of unpaid bills.
4. What is the role of employer-sponsored self-funded plans in ASC billing in Texas?
- Employer-sponsored self-funded plans are becoming more common in Texas, with employers contributing significantly to ASC billing reimbursements. This has led ASCs to adopt new payer models, including self-funded plans to streamline billing.
5. Why are bundled payment models gaining popularity among Texas ASCs?
- Bundled payments are popular in Texas ASCs because they allow a mix of fee-for-service and value-based care, ensuring a more predictable reimbursement model. This model is being adopted to create more consistent and efficient revenue streams for ASCs.
