The ASC Reimbursement Challenge: Concerns for 2023
Lower ASC reimbursement compared to hospital outpatient departments have been occurring for as long as we can remember. Leaders are increasingly worried about the impact on their margins as operating costs continue to rise. Thus, the ability to compete with hospital benefits and higher wages becomes a significant concern for ASCs. Despite these challenges, ASCs remain committed to maintaining high standards of safety, cleanliness, and patient satisfaction, even with limited resources.
While Medicare payments for ASC’s top 10 CPT codes are projected to increase by 3.9 percent in 2023, leaders express concerns that this may not be sufficient to offset rising inflation costs. Payers, on the other hand, are encouraging the migration of procedures to outpatient facilities, aiming to deliver surgeries and radiology services at cost-efficient sites of care. UnitedHealth Group, for example, plans to have more than 55 percent of its members’ outpatient surgeries and radiology services performed at ASCs by 2030.
Downward Pressure From Payers
Amidst these dynamics, some ASC leaders are apprehensive about the downward pressure from payers. They stress the need for both clinical expertise and alignment while also diligently focusing on ASC reimbursement aspects during negotiations. Leaders anticipate that providers will fight harder for better rates in contract negotiations with insurance companies in 2023. If negotiations are unsuccessful, some providers may opt out of certain contracts, resulting in more out-of-network providers for patients.
However, ASCs face challenges in securing favorable payer contracts due to competition from larger hospitals and health systems in many markets. Payer negotiations and issues consume significant time and effort for ASC administrators. The payment landscape for remains a significant challenge, with costs rising exponentially while ASC reimbursement fails to keep pace.
Advocating for Fair ASC Reimbursement
In navigating these concerns, ASC leaders recognize the importance of maintaining a strong focus on patient care, operational efficiency, and advocating for fair ASC reimbursement. They continue to work tirelessly to deliver high-quality care, improve patient outcomes, and address the financial challenges that lie ahead in an evolving healthcare environment.
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