AS I SEE IT
Maximizing Reimbursements and Compliance Outlook for ASCs providing cardiology and vascular surgery care BY JESSICA EDMISTON AND WENDY HORTON
Jessica Edmiston
Wendy Horton
Historically, card io logy and vas cular proce- dures were per- formed ex clu- sively in
a hos pi tal setting.
Nearly 20 years ago, however, many of these procedures began migrating to outpatient settings, such as renal dialy- sis centers, catheterization labs and endovascular labs, otherwise known as office-based vascular interventional laboratories (OBLs). The primary driv- ers for this movement included conve- nience, shorter appointment wait times and better outcomes for patients; greater control of technology and staff- ing, plus improved reimbursement, for physician owners of OBLs; and signif- icant cost savings for payers. Recently, due heavily to improve- medical technologies—
ments in
which now allow for more complex procedures to be performed in an out- patient setting—combined with signif- icant reductions in reimbursement for certain procedures in an OBL, many OBLs have launched ASCs and now operate in a hybrid OBL/ASC model. For example, the severe reductions in OBL-based reimbursement in the dialysis vascular access service arena in 2017 made it difficult for these facil- ities to survive, let alone thrive. In a hybrid model, the facility operates as an OBL on certain days of the week and as an ASC on the other days of the week. By moving to a hybrid model, these groups are able to take on addi- tional and more complex procedures, thus providing a high-quality and con- venient solution for their patients. This, in turn, simultaneously increases
When an OBL adds in an ASC, it is critical that the facility has a highly experienced ASC coding team handling the work as ASC coding is significantly different from OBL coding.”
— Jessica Edmiston and Wendy Horton National Medical
the volume and reimbursement for the providers and significantly improves the utilization and efficiency of the OBL/ASC.
While there has been a significant increase in Medicare-approved car- diology and vascular procedures that can be performed in an ASC recently, there still are many procedures that are not yet approved to be performed in an ASC. Thus, the two best options to per- form such procedures in an ASC today would either be in a hybrid OBL/ASC or in an already existing multispecialty ASC that can be tailored to perform such specialized procedures. Due to continued advancements in medical technology, however, it is highly likely that Medicare will approve more com- plex cardiology and vascular proce- dures, such as aneurysm repairs and carotid stenting, to be performed in an ASC. When approved. single-specialty cardiology and vascular ASCs will be fully utilized and highly profitable. If an OBL makes the decision
to move to a hybrid OBL/ASC, it will have to tackle numerous issues to make the transition. These issues
include, in most states, obtaining a cer- tificate of need; complying with the federal and state fraud and abuse and self-referral laws; obtaining and main- taining an ASC state license; satisfying the Medicare Conditions for Coverage; and focusing on key operational and revenue cycle differences in an ASC as compared to an OBL, such as sched- uling, registration, billing, coding and practice management.
Revenue Cycle and Coding Considerations If an OBL makes the decision to move to a hybrid OBL/ASC, it is critical to place significant emphasis on train- ing, particularly for the scheduling and medical coding functions. Given that the facility will be operating part time as an OBL and part time as an ASC, the scheduling team must be well-versed in the types of procedures that should be scheduled in an OBL as compared to an ASC, and be aware of the dates for each. Handling this correctly or incorrectly has a definite ripple effect on the rest of the revenue cycle and, ultimately, on reimbursement. When an OBL adds in an ASC, it is critical that the facility has a highly experienced ASC coding team han- dling the work as ASC coding is sig- nificantly different from OBL cod- ing. Ideally, the coders would all be ASC-certified and have significant cardiology and/or vascular experience to fully appreciate and manage the numerous differences. For example, a procedure performed in an OBL, or place of service 11, would have only one claim coded and submitted for reimbursement. It would be on the professional or physician
The advice and opinions expressed in this column are those of the authors and do not represent official Ambulatory Surgery Center Association policy or opinion. 10 ASC FOCUS APRIL 2018 |
www.ascfocus.org
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