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Conference Roundup
Medicare/Payer/Legislation

ASC Reimbursement Challenges Addressed

Posted on September 7, 2018

Reimbursement challenges and quality reporting for ambulatory surgery centers were addressed by Mary Pat Johnson, COMT, CPC, COE, CPMA, of the Corcoran Consulting Group in San Bernardino, CA, during the American Society of Cataract and Refractive Surgery’s 2018 annual meeting in Washington, DC. 

There is a trend toward more frequent ASC preauthorization, she noted. Some require the exact date the service will be performed, and will remain valid only for a short period. It is important to be aware of this in the event the patient cancels. Some payers provide a 1-year window, while others allow much narrower time-frames. This creates potential issues with performing second eye cataract procedures. 

Furthermore, some insurers do not allow certain laser surgery procedures to be performed in an ASC. Instead, they will pay only if it is performed as an office procedure. 

Because of these nuances, it is important to have a strong billing team and precise billing processes and systems. Immediate communication with payers is essential, said Johnson. 

Johnson M. Reimbursement challenges and mandatory quality reporting in your ASC. Talk presented at: 2018 ASCRS-ASOA Annual Meeting; April 13-17, 2018; Washington, DC.

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