3 Notable Trends in Medicare and Medicaid Reimbursement for ASCs

At the 12th Annual Spine, Orthopedic and Paine Management-Driven ASC Conference in Chicago on June 14, Paul Skowron — senior vice president of operations at Regent Surgical Health, which develops and manages surgery center partnerships — discussed the following three Medicare and Medicaid Reimbursement trends for ambulatory surgery centers.

1. Medicare isn't reimbursing ASCs properly for certain procedures in some cases. For instance, the program isn't paying for bilateral procedures appropriately in some cases, Mr. Skowron said. "Procedures billed with a certain modifier are being denied," he said, referring to the -50 modifier. "Claims are being denied for unreasonable reasons."

Device-intensive secondary procedures are also being paid at a rate of 50 percent in some cases, even though Medicare has indicated the procedure should be reimbursed 100 percent. Mr. Skowron advised ASC leaders to follow up with CMS if these particular procedures are underpaid and ensure secondary codes are billed properly. "The cost of the medical devices is so high that the effect on your reimbursement is going to be very material if you miss this," he said.

2. The Medicaid patient population is growing. As more patients become eligible for Medicaid as states expand their programs under the Patient Protection and Affordable Care Act, Medicare primary/Medicaid secondary patients are having a bigger impact on ASCs, according to Mr. Skowron. "Some facilities don't even know that they're not contracted with Medicaid," he said. "You'll want to get contracted, because all you'll get is the 80 percent from Medicare, and you'll be writing off the 20 percent from Medicaid."

3. Patients are increasingly opting out of Medicare. Insurance verification is more crucial than ever as greater numbers of seniors sign up for Medicare replacement plans, Mr. Skowron said. Some patients even get confused and opt out of the program without realizing that's what they're doing. "A lot of senior citizens don't know whether they're in Medicare or not," he said. "The importance of verifying insurance is compounded."

More Articles on ASC Reimbursement:
Reimbursement for Pain Management in the Coming Years  
Why ASCs Should Expand Relationships With GPOs  
New Reimbursement Models to Eclipse Fee-for-Service by 2020 

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