While ASCs have seen significant growth in recent years as CMS approves more procedures for the outpatient setting, technology advances and patient preferences shift — insurer policies and practices remain a key obstacle to ASC growth and sustainability.
Two ASC leaders recently joined Becker’s to discuss their biggest payer-related pain points and how they work around them.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Insurers are increasingly denying or delaying payment, and some providers are fighting back more aggressively — what’s your center’s biggest friction point with payers right now?
Ben Childers, MD. President and CEO Premier Outpatient Surgery Center (Riverside, Calif.): We get the run around from the Medical groups saying it is the responsibility of the parent insurance company. We find it very helpful when the doctor offices get as clean of authorization as possible. It does pose increased work on our billing departments.
Ellen Rostron. Business Operations Manager of Boston Out-Patient Surgical Suites: Insurers often deny claims or specific line items for CPT codes that were not included in the initial prior authorization request. Many payors permit submission of only a limited number of codes. Payors should be required to consider the entire relevant CPT code family when reviewing claims, as this approach could significantly reduce the time required for appeals related to anticipated surgical episodes.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
