Several legal and policy updates announced in the past month could affect reimbursement in ASCs.
Five changes to have on your radar:
1. Aetna is changing how it will handle certain ASC and ambulatory payment classification code edits, effective Nov. 1.
2. Beginning in July, CMS will reject a Medicare outpatient claim if the service location address doesn't exactly match the address listed on the 855A enrollment form in the Provider-Enrollment, Chain and Ownership System, or if a hospital with multiple locations doesn't report the correct location where the service was rendered.
3. Washington state passed a law designed to end a practice known as surprise billing. Republican Texas Gov. Gregg Abbott is expected to sign similar legislation banning surprise medical bills.
4. Vermont's House Health Care Committee approved a bill that will promote price transparency in the state. If signed into law, hospitals and ASCs will be required to provide patients a single bill with their entire financial obligation.
5. Medicare payments to ASCs have increased since 2012, according to MedPAC's 2019 report to Congress.