Medicare to save $73.4B with surgery in ASCs through 2028: 5 things to know
Content provided by Becker's ASC Review
A new report from the Ambulatory Surgery Center Association shows performing surgery on Medicare patients in ASCs instead of hospital outpatient departments saved $4.2 billion in 2018, and the savings are expected to climb significantly in the next decade.
KNG Health Consulting conducted an analysis of Medicare payment data from 2011 to 2018 on outpatient surgical procedures in ASCs and hospital outpatient departments. The analysis estimated historical and potential savings with a focus on total knee replacements.
Five key points:
1. Medicare saved $28.7 billion from 2011 to 2018 from surgeries performed in ASCs instead of hospital outpatient departments. The report projects Medicare will save $73.4 billion from 2019 to 2028, with $12 billion saved in 2028 alone.
2. The percentage of total knee replacement and knee mosaicplasty is expected to grow from 13.4 percent of all procedures in ASCs in 2020 to 18 percent in 2028, a 3.7 percent annual growth. Based on that projection, ASC savings for Medicare total knee replacements would be $2.95 billion from 2020 to 2028.
3. Most of the savings in the last decade are attributed to high-volume procedures, including cataract surgeries and colonoscopies, but the report estimates procedures such as endocrine, cardiovascular and orthopedic surgery will drive most of the $73.4 billion savings through 2028.
4. The following five specialties are expected to save Medicare $1 billion per year by being performed in the ASC:
5. There are more than 5,800 Medicare-certified ASCs in the U.S., with the most common procedures today being cataract surgery, colonoscopy, upper GI endoscopies and pain management procedures.
Click here to read more.
Content provided by Becker's ASC Review
A new report from the Ambulatory Surgery Center Association shows performing surgery on Medicare patients in ASCs instead of hospital outpatient departments saved $4.2 billion in 2018, and the savings are expected to climb significantly in the next decade.
KNG Health Consulting conducted an analysis of Medicare payment data from 2011 to 2018 on outpatient surgical procedures in ASCs and hospital outpatient departments. The analysis estimated historical and potential savings with a focus on total knee replacements.
Five key points:
1. Medicare saved $28.7 billion from 2011 to 2018 from surgeries performed in ASCs instead of hospital outpatient departments. The report projects Medicare will save $73.4 billion from 2019 to 2028, with $12 billion saved in 2028 alone.
2. The percentage of total knee replacement and knee mosaicplasty is expected to grow from 13.4 percent of all procedures in ASCs in 2020 to 18 percent in 2028, a 3.7 percent annual growth. Based on that projection, ASC savings for Medicare total knee replacements would be $2.95 billion from 2020 to 2028.
3. Most of the savings in the last decade are attributed to high-volume procedures, including cataract surgeries and colonoscopies, but the report estimates procedures such as endocrine, cardiovascular and orthopedic surgery will drive most of the $73.4 billion savings through 2028.
4. The following five specialties are expected to save Medicare $1 billion per year by being performed in the ASC:
- Eye and ocular adnexa
- Cardiovascular
- Nervous system
- Digestive system surgery
- Musculoskeletal surgery
5. There are more than 5,800 Medicare-certified ASCs in the U.S., with the most common procedures today being cataract surgery, colonoscopy, upper GI endoscopies and pain management procedures.
Click here to read more.
CMS proposes cutting Medicare payments for some specialty surgeries 6%-9%
Content provided by: Becker's ASC Review
CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which made several drastic cuts to payment rates for both general and specialty surgeons.
What you should know:
1. The rule would drop the conversion factor by $3.83 to $32.26. The current conversion factor is $36.09.
2. General surgeons will see their Medicare reimbursement rates cut by 7 percent under the proposed rule.
3. The following specialties will see the biggest impacts to their reimbursement rates:
5. The Surgical Care Coalition is lobbying Congress to waive Medicare's budget neutrality requirements for these E/M adjustments and increase all 10- and 90-day global code values.
6. In a recent survey conducted by the SCC, private surgical practitioners said the proposed rule would likely force surgeons to take fewer Medicare patients.
7. The rule also solidified the COVID-19-related temporary changes made to increase access to telehealth. The proposed rule would make those temporary changes permanent.
Read more here.
Content provided by: Becker's ASC Review
CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which made several drastic cuts to payment rates for both general and specialty surgeons.
What you should know:
1. The rule would drop the conversion factor by $3.83 to $32.26. The current conversion factor is $36.09.
2. General surgeons will see their Medicare reimbursement rates cut by 7 percent under the proposed rule.
3. The following specialties will see the biggest impacts to their reimbursement rates:
- Cardiovascular surgeons: 9 percent
- Thoracic surgeons: 8 percent
- Vascular surgeons: 7 percent
- Neurosurgeons: 7 percent
- Ophthalmologists: 6 percent
5. The Surgical Care Coalition is lobbying Congress to waive Medicare's budget neutrality requirements for these E/M adjustments and increase all 10- and 90-day global code values.
6. In a recent survey conducted by the SCC, private surgical practitioners said the proposed rule would likely force surgeons to take fewer Medicare patients.
7. The rule also solidified the COVID-19-related temporary changes made to increase access to telehealth. The proposed rule would make those temporary changes permanent.
Read more here.
State Hits Medicaid Plans for Contract Breaches
Content provided by: The News Service of Florida
Managed care plans were sanctioned 187 times and paid more than $2 million in damages during the 2019-2020 state fiscal year for breach of Medicaid contracts, according to information released by the state. The Florida Agency for Health Care Administration website shows that during the fiscal year, which ended June 30, 13 Medicaid managed-care health plans, one Medicaid specialty plan and three managed dental plans faced sanctions for failing to adhere to contract requirements. Staywell Health Plan, which has the largest market share in the state’s Medicaid managed-care system, had the most sanctions with 24 and the largest amount of liquidated damages with $668,150, according to the data, which was made publicly available Friday. Eight of the sanctions against the company stemmed from “provider services” violations, which included issues related to network adequacy, payment, credentialing and contracting and untimely or inaccurate reporting. For those eight violations, Staywell paid $261,750 in damages. Overall, provider services accounted for nearly one-third of the total number of sanctions during the fiscal year, with the state assessing $673,250 in liquidated damages against plans for 61 violations. In terms of dollars, though, state regulators assessed $732,050 in damages when managed care plans failed to follow contract requirements for covered services and authorizations. The state has contracts with 13 managed care companies to offer health services to poor, elderly and disabled people. The state also has contracts with five managed care plans to provide specialty services --- such as mental health services, care for people with HIV and AIDS and care for children with chronic medical conditions—and contracts with three managed dental-care companies.
Click here to read more. (News Service of Florida subscription required)
Content provided by: The News Service of Florida
Managed care plans were sanctioned 187 times and paid more than $2 million in damages during the 2019-2020 state fiscal year for breach of Medicaid contracts, according to information released by the state. The Florida Agency for Health Care Administration website shows that during the fiscal year, which ended June 30, 13 Medicaid managed-care health plans, one Medicaid specialty plan and three managed dental plans faced sanctions for failing to adhere to contract requirements. Staywell Health Plan, which has the largest market share in the state’s Medicaid managed-care system, had the most sanctions with 24 and the largest amount of liquidated damages with $668,150, according to the data, which was made publicly available Friday. Eight of the sanctions against the company stemmed from “provider services” violations, which included issues related to network adequacy, payment, credentialing and contracting and untimely or inaccurate reporting. For those eight violations, Staywell paid $261,750 in damages. Overall, provider services accounted for nearly one-third of the total number of sanctions during the fiscal year, with the state assessing $673,250 in liquidated damages against plans for 61 violations. In terms of dollars, though, state regulators assessed $732,050 in damages when managed care plans failed to follow contract requirements for covered services and authorizations. The state has contracts with 13 managed care companies to offer health services to poor, elderly and disabled people. The state also has contracts with five managed care plans to provide specialty services --- such as mental health services, care for people with HIV and AIDS and care for children with chronic medical conditions—and contracts with three managed dental-care companies.
Click here to read more. (News Service of Florida subscription required)
Administration considering ban on “surprise” medical bills
Politico (5/27, Luthi, Roubein) reports the administration is “floating a plan that would outlaw health care providers from putting patients on the hook for thousands of dollars in expenses” as part of “surprise” medical bills, but the plan has not mandated “how doctors and hospitals would recover their costs from insurers, according to administration officials, Capitol Hill aides and industry lobbyists familiar with discussions.” However, “powerful doctors groups,” such as the American Medical Association, are “wary of a policy that only bans the practice and doesn’t include a way to resolve payment disputes,” contending “the approach would leave health insurers with too much leverage.” AMA President Patrice A. Harris, M.D., M.A., said in a statement, “As there is no balance billing for COVID testing and treatment under most types of insurance, there is no need to rush these significant policy changes as part of the next COVID relief package.”
Politico (5/27, Luthi, Roubein) reports the administration is “floating a plan that would outlaw health care providers from putting patients on the hook for thousands of dollars in expenses” as part of “surprise” medical bills, but the plan has not mandated “how doctors and hospitals would recover their costs from insurers, according to administration officials, Capitol Hill aides and industry lobbyists familiar with discussions.” However, “powerful doctors groups,” such as the American Medical Association, are “wary of a policy that only bans the practice and doesn’t include a way to resolve payment disputes,” contending “the approach would leave health insurers with too much leverage.” AMA President Patrice A. Harris, M.D., M.A., said in a statement, “As there is no balance billing for COVID testing and treatment under most types of insurance, there is no need to rush these significant policy changes as part of the next COVID relief package.”
Critical-access, acute-care hospitals received more than 80% of $100 billion CMS sent to providers during pandemic
Content Provided by: Modern Healthcare
Modern Healthcare (5/20, Cohrs, Subscription Publication) reports, “Acute-care and critical-access hospitals received more than 80% of the $100 billion that CMS sent out to providers to help improve their cash flow as revenue dried up due to the COVID-19 pandemic.” Providers who had “heavy Medicaid payer mixes were eligible for proportionally fewer funds than those with more Medicare patients.” In addition, “Medicaid providers were also disadvantaged by the formula used by HHS to distribute grant funds.”
Content Provided by: Modern Healthcare
Modern Healthcare (5/20, Cohrs, Subscription Publication) reports, “Acute-care and critical-access hospitals received more than 80% of the $100 billion that CMS sent out to providers to help improve their cash flow as revenue dried up due to the COVID-19 pandemic.” Providers who had “heavy Medicaid payer mixes were eligible for proportionally fewer funds than those with more Medicare patients.” In addition, “Medicaid providers were also disadvantaged by the formula used by HHS to distribute grant funds.”
Strategic Alliance Provides a Wealth of Resources for Physician Practices
Cobbe Consulting & Management (CCM) and Acevedo Consulting Incorporated (ACI) today announced a strategic partnership to provide coding, compliance and regulatory training for our physician practices.
This partnership will make multiple programs available for our members that cover topics such as CPT, HCPCS, ICD-10-CM, third-party billing rules, reimbursement, as well as other services necessary to navigate the complex world of healthcare. Acevedo Consulting Incorporated specializes in coding, compliance, appeals, due diligence, HIPAA, education, physician and staff training, and more. All consultants at ACI are credentialed by the AAPC, Health Care Compliance Association and/or AHIMA.
The healthcare industry is ever evolving and so are the guidelines that practices must follow. Working in such a highly regulated industry requires strict adherence for regulatory compliance. Cobb Consulting is working to ease that burden for its members by providing access to a firm that specializes in compliance. The partnership between CCM and ACI helps ensure that physician practices have a trusted resource to help them navigate regulatory compliance.
“Acevedo Consulting Incorporated is known for their professional expertise and does phenomenal work for their clients. This partnership will help us better serve our members by giving them access to such a great firm,” said Fraser Cobbe, CEO of Cobbe Consulting & Management.
About Cobbe Consulting & Management
Cobbe Consulting & Management is an Association Management Company that specializes in representing medical associations across the country with a strong presence throughout the State of Florida. With over 20 years of experience in organized medicine, CCM represents some of the largest and historically significant organizations in the state including: Bones Society of Florida, Dade County Medical Association, Duval County Medical Society, Florida Orthopaedic Society, Florida Society of Nephrology, and the Physicians Society of Central Florida. CCM specializes in delivering unique programs and services and educational opportunities to the thousands of physicians and medical executives they represent in their family of organizations.
About Acevedo Consulting Incorporated:
Our consulting staff is nationally recognized for its expertise and our consultants are credentialed by the Health Care Compliance Association (HCCA), American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA). The consultants’ 100+ years of combined and varied experience in the health care field are invaluable to the firm’s clients. Besides the requisite coding and compliance credentials and expertise, our consultants’ experiences range from serving in upper-level administrative and compliance positions for large hospital-based physician organizations and health plans. Members of our team are often lecturing at national organization and specialty society conferences, serving as an Investigative Consultant for the Department of Justice (DOJ) and as the IRO for organizations under a CIA. Acevedo Consulting often serves as an expert witness, renders opinions on expected fraudulent billing, assists with overpayment appeals, and conducts pre-acquisition and pre-employment Due Diligence.
Cobbe Consulting & Management (CCM) and Acevedo Consulting Incorporated (ACI) today announced a strategic partnership to provide coding, compliance and regulatory training for our physician practices.
This partnership will make multiple programs available for our members that cover topics such as CPT, HCPCS, ICD-10-CM, third-party billing rules, reimbursement, as well as other services necessary to navigate the complex world of healthcare. Acevedo Consulting Incorporated specializes in coding, compliance, appeals, due diligence, HIPAA, education, physician and staff training, and more. All consultants at ACI are credentialed by the AAPC, Health Care Compliance Association and/or AHIMA.
The healthcare industry is ever evolving and so are the guidelines that practices must follow. Working in such a highly regulated industry requires strict adherence for regulatory compliance. Cobb Consulting is working to ease that burden for its members by providing access to a firm that specializes in compliance. The partnership between CCM and ACI helps ensure that physician practices have a trusted resource to help them navigate regulatory compliance.
“Acevedo Consulting Incorporated is known for their professional expertise and does phenomenal work for their clients. This partnership will help us better serve our members by giving them access to such a great firm,” said Fraser Cobbe, CEO of Cobbe Consulting & Management.
About Cobbe Consulting & Management
Cobbe Consulting & Management is an Association Management Company that specializes in representing medical associations across the country with a strong presence throughout the State of Florida. With over 20 years of experience in organized medicine, CCM represents some of the largest and historically significant organizations in the state including: Bones Society of Florida, Dade County Medical Association, Duval County Medical Society, Florida Orthopaedic Society, Florida Society of Nephrology, and the Physicians Society of Central Florida. CCM specializes in delivering unique programs and services and educational opportunities to the thousands of physicians and medical executives they represent in their family of organizations.
About Acevedo Consulting Incorporated:
Our consulting staff is nationally recognized for its expertise and our consultants are credentialed by the Health Care Compliance Association (HCCA), American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA). The consultants’ 100+ years of combined and varied experience in the health care field are invaluable to the firm’s clients. Besides the requisite coding and compliance credentials and expertise, our consultants’ experiences range from serving in upper-level administrative and compliance positions for large hospital-based physician organizations and health plans. Members of our team are often lecturing at national organization and specialty society conferences, serving as an Investigative Consultant for the Department of Justice (DOJ) and as the IRO for organizations under a CIA. Acevedo Consulting often serves as an expert witness, renders opinions on expected fraudulent billing, assists with overpayment appeals, and conducts pre-acquisition and pre-employment Due Diligence.
Bill Correctly for Medicare Telehealth Services (2/2020)
In a recent report, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services video to help you bill correctly.
Additional resources:
Source: CMS
In a recent report, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services video to help you bill correctly.
Additional resources:
- Telehealth Services (PDF) Medicare Learning Network Booklet
- Medicare Claims Processing Manual, Chapter 12 (PDF), Section 190
- Medicare Telehealth Payment Eligibility Analyzer
- List of Covered Telehealth Services webpage
- CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements OIG Report
Source: CMS
Over 1,500 health care organizations hit with successful ransomware attacks since 2016, report says
HealthIT Security (2/13, HealthITSecurity) reports “more than 1,500 health care organizations have been hit with successful ransomware attacks since 2016, costing the sector over $160 million during that time, according to a recent report from Comparitech, a company that provides consumers with privacy information, tools, and comparisons.”
HealthIT Security (2/13, HealthITSecurity) reports “more than 1,500 health care organizations have been hit with successful ransomware attacks since 2016, costing the sector over $160 million during that time, according to a recent report from Comparitech, a company that provides consumers with privacy information, tools, and comparisons.”
House committee approves surprise billing legislation
The Hill (2/11, Sullivan) reports the House Education and Labor Committee approved a bill that would protect patients from surprise medical bills. The article says that the bill will now be sent to the full House alongside competing bills.
The Hill (2/11, Sullivan) reports the House Education and Labor Committee approved a bill that would protect patients from surprise medical bills. The article says that the bill will now be sent to the full House alongside competing bills.
House Ways and Means Committee releases legislation on surprise medical bills
The Hill (2/7, Sullivan) reported the House Ways and Means Committee “released their legislation to protect patients from getting massive, surprise medical bills, as congressional action on the subject intensifies.” Reps. Richard Neal and Kevin Brady, the committee’s leaders, both support the legislation, which “would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of their doctors happens to be outside their insurance network.”
The Hill (2/7, Sullivan) reported the House Ways and Means Committee “released their legislation to protect patients from getting massive, surprise medical bills, as congressional action on the subject intensifies.” Reps. Richard Neal and Kevin Brady, the committee’s leaders, both support the legislation, which “would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of their doctors happens to be outside their insurance network.”
310 ASCs with total joint replacements
Source: Becker's Healthcare
Written by Laura Dyrda | April 29, 2019
Total joint replacements are moving to the outpatient setting, with more than 300 ASCs across the country including total knee and hip procedures.
Here is a list of those centers. To add a center to this list, contact Laura Dyrda at ldyrda@beckershealthcare.com.
Written by Laura Dyrda | April 29, 2019
Total joint replacements are moving to the outpatient setting, with more than 300 ASCs across the country including total knee and hip procedures.
Here is a list of those centers. To add a center to this list, contact Laura Dyrda at ldyrda@beckershealthcare.com.
South Carolina
- Carolina Bone & Joint Surgery Center (Myrtle Beach, S.C.).
- Carolina Coast Surgery Center (Murrells Inlet, S.C.)
- Charleston Surgery Center (North Charleston, S.C.)
- Lowcountry Outpatient Surgery Center (Summerville, S.C.)
- Midlands Orthopedic Surgery Center (Columbia, S.C.)
- Spartanburg (S.C.) Surgery Center
- Surgery Center at Pelham (Greer, S.C.)