Commercial and government payers alike are increasingly pushing patients to ASCs because of the cost-savings they can offer.
Here are five examples of payers pushing procedures and physicians to ASCs since 2019, according to a September blog post by law firm Hendershot Cowart and prior Becker's coverage:
Aetna
In 2022 and in 2023, according to the blog post, Aetna expanded the list of procedures that can be provided without precertification if performed in an ASC.
The Blue Cross Blue Shield Association
In January 2023, the Blue Cross Blue Shield Association released a policy statement backing site-neutral payments as a key focus for saving billions of dollars in the next 10 years. The report notes a 12% increase in physician practices owned by hospitals, health systems, private equity and other corporate firms over the last two years.
Blue Cross and Blue Shield of Texas
In 2022, Blue Cross and Blue Shield of Texas increased the maximum allowable standard fee schedule reimbursement for nearly 1,500 outpatient surgery services when performed at in-network ASCs. In 2023, the payer did the same with 63 additional outpatient surgery services.
Empire BlueCross BlueShield in New York
In 2021, Empire BlueCross BlueShield in New York updated its coverage policy to drive more surgical procedures to ASCs. Empire commercial plan members now need a medical necessity review to have certain procedures performed in the HOPD setting instead of an ASC.
United Healthcare
In 2019, United Healthcare implemented a policy requiring members to receive nonurgent surgical procedures in an ASC unless an HOPD is medically necessary or an ASC is not geographically accessible. UnitedHealthcare’s 2023 site-of-service policy, which went into effect April 2023, includes 1,041 codes for commercially insured patients and 167 codes for Medicare Advantage patients that require pre-authorization for the surgery to be performed in an HOPD.