Regent RCM logo

ASC Revenue Cycle October Industry News Wrap-Up

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the healthcare industry. This month in the news: The new MACRA final rule released by the Centers for Medicare and Medicaid Services (CMS) contains aspects that will impact ASCs; A new editorial weighs the pros and cons of “condiminiumizing” ASCs; Key specialties coming for ASCs next year; And a Deloitte survey reveals that a large number of physicians are still paid under fee-for-service payment model.

MACRA Final Rule Released

On Friday, October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule that established the new Medicare payment methodology for physician services furnished under Medicare Part B, known as the Quality Payment Program (QPP). The rule contains many components that will impact ASCs. The QPP was enacted in 2015 as part of the Medicare Access and CHIP Reauthorization Act (MACRA) and has two participation options for physicians: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Reporting for the first year of the QPP begins in 2017. Click here to read more.

ASCs: To Be or Not To Be “Condominiumized”

In an editorial, Stephen Sheppard, CPA, COE, reveals the pluses and minuses around the concept of “condominiumizing” ambulatory surgery centers (ASCs). This model involves separating a single physical ASC plant temporally among two distinct legal entities. For example, ASC-A could operate on Monday, Wednesday, and Friday, while ASC-B could operate on Tuesday and Thursday. Sheppard outlines the opportunities and obstacles. Click here to read more.

Key Specialties Coming for ASCs in 2017 

Ambulatory surgery centers are performing higher acuity cases and presenting opportunities for the healthcare system to provide quality care for patients at a lower cost. Paul Eiseman, vice president of business development at Regent Surgical Health, shares insights into specialties that have fared well in the ASC space and what is in store for 2017. Click here to read more.

Deloitte Survey: 86% of Physicians Are Still Paid Under Fee-For-Service Payment Model

Deloitte’s “2016 Survey of U.S. Physicians” survey has revealed that many physicians are reimbursed under a fee-for-service model instead of the value-based system in which providers are paid according to outcomes. Click here to read more.

Regent RCM

ASC Revenue Cycle September Industry News Wrap-Up

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.