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7 reimbursement updates for ASCs, key insights

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Here are seven reimbursement updates for ASCs from the first quarter:

1. The FDA declined to extend National Coverage Determination to Epigenomics AG for its Epi proColon, a blood-based colorectal cancer screening test, the company announced Jan. 21.

2. CMS released a notice March 17 that it was walking back four telehealth service codes that the agency said were inadvertently included on its final list because of technical errors.

3. CMS delayed a final rule that aims to speed up the FDA approval process for Medicare coverage of new medical devices and technologies.  

4. CMS has approved ASCs as a site of service for transcervical uterine fibroid ablation — a minimally invasive procedure for symptomatic uterine fibroids that can be performed with the Sonata System developed by women's healthcare company Gynesonics — the company announced March 9.

5. CMS will implement an automatic extreme and uncontrollable circumstances policy for some clinicians participating in the Quality Payment Program's Merit-based Incentive Payment System, it announced Feb. 25.

6. Here's how President Joe Biden's $1.9 trillion relief law could help lighten COVID-19 backlogs.

7. Here's how incorrectly documenting your anesthesia service can cost you your reimbursement.

Key reimbursement insights:

Brian Bizub. CEO of Raleigh (N.C.) Orthopaedic: The biggest challenge is with every move of an inpatient surgical case to the ASC is a substantial reduction in reimbursement, leaving little to no margin for profit unless the government engages in equipment, instrumentation, supply chain and implant costs similar to CMS' competitive bidding process on durable medical equipment and average sales price for medications.

Joe Feuerstein, MD. Gastroenterologist at Beth Israel Deaconess Medical Center (Boston): I think in many ways the biggest threats to GI are both changes in reimbursements and evolving with medical advances.

On a nearly yearly basis, gastroenterologists need to deal with the concerns of reduced reimbursements for the same work. While this may provide short-term cost savings for insurers, it shifts an increasing burden on practitioners to increase their volume to maintain stable revenue. Ideally this process should be more sustainable and changing with inflation as opposed to a yearly debate on whether or not reimbursements should be decreased.

Vincent Hayes. COO of Florida Digestive Health Specialists (Bradenton): When COVID-19 hit, our teams selected and launched a new telemedicine system in one weekend. And while other health systems cut physician salaries, we onboarded seven new gastroenterologists and opened two new clinics. We're able to keep operational costs low, streamline administration tasks and use our large market share to negotiate better reimbursement rates.

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