Prepare now for more stringent joint replacement documentation requirements
Medicare administrative contractors (MACs) in several states recently ratcheted up their documentation requirements for joint replacement surgery and other orthopedic procedures. For hospital ORs, these changes represent the tip of an iceberg that calls for careful navigation. Enhanced medical necessity documentation requirements were launched in Florida in 2011. The state’s…
Medicare reimbursement, allowable procedures at forefront of ASC challenges
Leaders of ambulatory surgery centers (ASCs) can expect to continue facing challenges related to reimbursement even as they try to increase the kinds of procedures that can be performed in their facilities, say experts with the Ambulatory Surgery Center Association (ASCA). Other key factors that will determine their future success…
CMS issues proposed hospital inpatient payment rule
The Centers for Medicare & Medicaid Services (CMS) on April 30 issued its proposed rule that would update FY 2015 Medicare payment polices and rates for inpatient stays at general acute care and long-term care hospitals. The proposed rule will increase the payment rate to general acute care hospitals by…
Anticipate & educate to navigate murky healthcare reform waters
Anxiety over changes in healthcare delivery and payment systems has permeated hospitals and ambulatory surgery centers (ASCs). Administrators are concerned about how the Affordable Care Act (ACA) and other initiatives will hit the organization’s bottom line. Increasingly, perioperative services leaders are being drawn into discussions in these areas. “The OR…
Planning for postoperative care: A key strategy for reducing readmissions
With the expansion of Medicare readmission penalties to elective total-knee and total-hip arthroplasty patients in 2014 comes an increasing demand for OR leaders to ensure better postdischarge care. To avoid readmissions, OR management will have to be more proactive about reducing length of stay and complications and providing for care…
ACA will bring more patients to ASCs--but will profits follow?
The Patient Protection and Affordable Care Act (ACA) is affecting every part of the healthcare system, including ambulatory surgery centers (ASCs). Whether it will help or hinder ASCs, however, will depend on how adept they are at managing changes in the way they are paid and how they interact with…
Comprehensive dashboards paint a fuller picture of OR performance
OR Business Performance is a series intended to help OR managers and directors improve the success of their business. Data-rich dashboards are an effective way to communicate with surgeons and align them with OR goals, but many reporting strategies have not kept pace with changes in the surgery market.…
New quality measures, tight deadline mark CMS payment rule for ASCs
It sounds like déjà vu all over again, as Yogi Berra used to say. That is likely to be the first reaction of many ambulatory surgery center (ASC) administrators to the Calendar Year 2014 Ambulatory Surgical Center Payment Proposed Rule. Pay formula unchanged Medicare payment updates would continue at…
ASC executives to meet with lawmakers
The Ambulatory Surgery Center Association (ASCA) annually asks members to participate in a “fly-in” to meet with members of Congress to raise awareness about the implications of health care policies. As ASCA vice president of government relations Steve Miller notes, there is nothing like hearing directly from a constituent to…
Can your OR documentation stand up to a RAC audit?
A column on managing the OR revenue cycle. Audits of Medicare payments to hospitals are up dramatically. In all, 89% of hospitals reported activity by recovery audit contractors (RACs) in the third quarter of 2012, according to an American Hospital Association (AHA) survey. Here are tips on how your OR…
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