ASC’s Revenue Cycle: Regulatory Affairs Affecting Payer Contracts

Former President Barack Obama signed the new healthcare reform Affordable Care Act (ACA) in 2010 with great support and opposition from Republicans. With Trump administrations making ACA a major focus during the campaign and even trying to repeal the ACA of 2010 with the new reform. Currently, legislators are considering multiple plans to revise the current act in turn affecting the ASC medical billing. Healthcare legislative effort 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 be disrupting the current patient financial responsibly for the large portion of their care. If the current trend continues we can expect some major challenges which 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 the recent data, 83 percent of the patients are directly or indirectly (through employees) contributing to the medical reimbursement.

As the patient contribution has increased towards the reimbursement of providers this has impacted the revenue generation. Almost 25 percent of the revenue for the providers is now coming through self-pay and resulting in bad debt for ASC facilities across the USA.  Currently, more than 15 percent of consumers are failing to pay medical bills this 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 for maintaining quality and care.

With rising ASC provider costs are now looking for alternative methods for the lean and efficient methods as this becomes possible, leading to a requirement for automation or an outsourced team of medical billers and coders. ASC facilities are now seeking simpler and are adopting the 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 the employers have increased to 82 percent. Due to these employers are now becoming a part of medical reimbursement and one of the significant parts in the 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 on ASC facilities and in turn employees are seeking ASC facilities for primary care. So with a view of such a situation, the industry is adopting a new payer class that can be self-funded. ”

The insurance companies are now trying to take the route of employers groups for adopting the new business model with ASC facilities. Depending on the market there could be a profitable arrangement for ASC facilities with the employer’s group are now taking the area and contracts implementing the timely payment.

ASC Bundled Payment

Bundled Payment is becoming a major part of the ASC facilities with expanding service requirements.  With 97 percent of health plans from employers are the addition of fee-for-service and value-based reimbursement for the ASC facilities. ASCs are currently taking the responsibility of bundled payment to understand payer contracts to 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.

Get to know how to make your ASC billing regulation impact-free with outsourcing medical billing.