Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the health care industry. This month in the news: A story that describes the benefits that California ASCs gain from bundled payments; In its final rule on emergency preparedness, CMS has set new guidelines for ambulatory surgery centers (ASCs); and ICD-10’s impact on revenue cycle management a year after implementation;
Will the bundled payment model work for ASCs?
Even though bundled care has not been widely adopted in the ambulatory environment with commercially insured or federally insured patients, bundled surgical cases in California yielded positive financial and patient satisfaction results over a five-year span. From 2010 to 2015, over 2,000 commercially insured bundled surgical cases such as total and partial joint replacement and repair, major spine surgery, hysterectomy, thyroidectomy, mastectomy and breast reconstruction, were performed in California ASCs with overnight stay capability administered by Global One Ventures. In these bundled payment cases, 98 percent said they would recommend a bundled payment methodology to friends. Complication rates were low, with a combined rate of subsequent emergency room (ER) visits, infections and readmissions of 0.67 percent in 2015. And financial savings were significant with an average of $7,648 per case. The total cost is 30–60 percent less per bundled case than if the procedure had been performed in the hospital setting. Click here to read more.
CMS Releases Final Rule on Emergency Preparedness
The Centers for Medicare and Medicaid Services published its final rule for emergency preparedness on Sept. 16, which is scheduled to go into effect 60 days after publication. The final rule exempts ASCs from providing information about occupancy. However, ASCs are required to create a process to cooperate with local, regional, state and federal efforts for emergency preparedness in their community. Additionally, the final rule requires ASCs to document efforts to connect with emergency preparedness officials and collaborate in planning efforts when available. Click here to read more.
A Year Later: ICD-10’s Impact on Revenue Cycle Management
Last year, U.S. providers feared falling productivity, increased denials and reduced revenue as they prepared for the inevitable shift from ICD-9 to ICD-10. The new coding system increased diagnostic codes from approximately 14,000 to more than 68,000 and procedure codes from 4,000 to 87,000 with promises to improve quality reporting and outcomes measurement, and streamline reimbursement processes. What has been ICD-10’s influence on billing operations a year after implementation? Click here to read more.