Q: What is a common mistake ASCs make regarding reimbursement for surgical implant procedures?
Pat McCaffrey: One of the biggest mistakes ASCs make is that they tend to view implants as a profitable revenue stream, but that’s often not the case. Surgeries utilizing implantable devices are complex, and because we still lack standards that uniquely codify devices and all of their components, the reimbursement process is highly manual for both payors and providers. This complex, manual process manifests itself in several ways for the ASC:
1. Payor payment policy may exclude devices and/or device components, resulting in some number of claims where the reimbursement for devices is $0.
2. Cost-plus reimbursement contracts require providers to submit invoices and payors to audit the invoices against the claims. This highly manual process increases operational costs for ASCs (and payors) and significantly increases the number of days that claim payment is outstanding. In our experience, the cash-flow impact of delayed payment exceeds the small “profit” the ASC believes they are making on the device itself.
ASCs need to look at the whole reimbursement picture and understand the impacts of payment policy and delayed reimbursement on profitability and cash-flow. They then need to look at options to increase the speed at which claims are paid, thereby improving cash flow and overall financial performance.
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