Channel Sponsor - Coding/Billing/Collections

Sponsored by National Medical Billing Services | info@nationalASCbilling.com | (636) 273-6711

This major commercial insurer is steering patients to ASCs — Here's how

In March 2019, Blue Cross and Blue Shield of Minnesota instituted a site-of-service policy asking physicians to refer patients to high-quality, low-cost care at ASCs when medically appropriate.

With claims data showing that members who have a $2,000 deductible and 20 percent coinsurance would save, on average, $260 in out-of-pocket costs for common gastrointestinal procedures by receiving care at an ASC, Blue Cross launched the program to help lower patient expenses, overall healthcare costs, and ultimately, premiums.

Based on substantial evidence that ASCs can be a convenient and cost-effective alternative to inpatient or outpatient hospital settings, the site-of-service program currently includes some types of gastrointestinal, otolaryngology, hernia, gynecology, orthopedic arthroscopy and foot procedures.

A patient who has one of the covered services performed at a hospital when it should have been performed at a lower-cost setting will not have to pay full price out of pocket.

An in-network hospital is exempt from the policy and is covered in the following circumstances:

  • The hospital agreed to provide services at a lower cost for Blue Cross members
  • There is no ASC providing the services within 25 miles of the hospital
  • There is no in-network ASC providing the services within 25 miles of the member's home

In its efforts to manage costs and quality, Blue Crossadvises members to request that their procedure be done at an ASC, make sure that ASC is in network and confirm coverage when receiving care in a hospital outpatient setting.

More articles on surgery centers:
10 recent ASC leadership moves
Virginia ASC takes infection prevention to new level — 3 insights
Surgery Partners goes all-in on cardiology — 5 quotes on its quarterly performance

© Copyright ASC COMMUNICATIONS 2021. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.