As procedure reimbursement rates continue to change nationwide, ASC leaders are concerned about maintaining profitability while providing top-level care to patients. Here is why two leaders are concerned about the future of reimbursement rates.
Question: What are your biggest concerns regarding procedure reimbursements right now?
Ali Ghalayini. Administrator at Munster (Ind.) Surgery Center: Keeping in mind that procedure reimbursements may vary depending on the location, market and regulatory environment, here are some primary concerns and factors.
The shift towards value-based care and bundled payments for procedures can impact the profitability of an ASC. Bundled payments require ASCs to provide a comprehensive package of services for a single price, which may affect the margins on individual procedures.
Also, accurate coding and billing are crucial for receiving the correct procedure reimbursement. Errors in coding or billing can lead to underpayment, delayed payments, or even denials from payers, in addition to factors such as regulatory changes and reimbursement rates, out-of-network reimbursements and competition from hospital outpatient departments.
Joshua Radeker. Center Director at Orthopaedic Surgery Center (Gainesville, Fla.): The highest concern we have regarding procedure reimbursements lies in moving our commercial payers to enhance/increase our contracts as the industry, Medicare and the cost environment recognizes the savings when a case is moved from the hospital to an ASC.
We have several large commercial payers that view our market-based increase requests as a significant jump from current contract levels and percentages. While that math is accurate, the site of service change to our ASC still saves two to four times from that procedure being performed in a hospital setting. That provides ultimate savings to the entire system.