ASC Billing Guidelines for 2019

Ambulatory surgical centers in the USA have not shown any significant growth in the past few years. Many of them either closed down or merged with bigger medical groups due to revenue issues. According to Pro-vista Report of ASC Survey Findings, reimbursement is the biggest challenge faced by ASCs across the country along with management of days in A/R.

2019 will demand effective revenue cycle management for ambulatory surgery centers. This is because even after changes made by CMS to support ASCs, there are some centers that continue to face difficulties in managing their revenue cycles.

Following are few of the important changes introduced by CMS in its 2019 proposed payment rule for ASCs:

  • The reimbursement rate is increased by 2.1% on an average on all covered procedures for ASCs. However, not every procedure will experience this change, as it is code-specific.
  • The bottom line has been lowered from 40% to 30% for device intensive procedures.
  • Non-opiod pain management drugs will receive separate payments.
  • The definition of ‘surgery’ is being revised and is proposed to include other surgery like procedures. Also, 12 cardiac catherization procedures are proposed to be added to the current ASC covered list.
  • ASC Quality Reporting Program witnessed some big changes. ASC-8 will be removed from 2020, and beginning 2021, ASC-10 will also be removed.


Billing Guidelines for ASC in 2019

  • Understanding the currently effective billing and payment guidelines is the most important step that the ASC billing team will have to achieve in order to diminish RCM concerns.
  • Billers will have to ensure that the days in A/R for the surgical center is reduced. For this, the center will have to effectively handle procedure scheduling, insurance verification, patient financial counselling, patient collections, patient payment plans, patient pre-registration and so on.
  • Error-free coding is the lifeline of every surgical center. In 2018, AMA added 170 new codes, deleted 82 codes and revised 60 codes. So in order to sail through 2019, ASCs will need expert coders who are aware of the current CPT and ICD-10 codes and revisions.
  • ASCs will also have to manage and keep up with the payer contracts because they are also subject to frequent changes.
  • To avoid Medicare payment reductions in 2020 under the ASC quality Reporting Program, providers will have to invest time and effort into making sure that the measures are being reported correctly.


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