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The Impact of 2022’s Policy Changes on Your ASC’s Spine Program and How to Navigate the Change

By Admin | March 29, 2022

In recent years, more and more complex surgical spine procedures have migrated to the ambulatory surgery center (ASC). Advances in technology and surgical technique, strategic patient selection, and payer policy updates have aided in this migration.

The recent reversal of several key provisions in the Centers for Medicare and Medicaid Services (CMS) Outpatient Prospective Payment System/ASC Payment system (OPPS) final rulings between CY 2021 and CY 2022, however, could have a negative impact to an ASCs profitability if these and other policy transitions are not managed effectively. As a result, many ASCs are focusing on detailed revenue cycle assessments; engaging specialized partners to ensure compliance with current regulation, and to review current operational processes for growth opportunities. 

Overall, the past decade has shown positive forward migration of spine procedures into the ambulatory surgery center place of service. Calendar years 2015 through 2021 delivered new spine procedure codes to the ASC covered procedure list (ASC-CPL). After sweeping policy change in the CY 2021 final ruling, hundreds of new codes, including many outside of the spine specialty, were automatically placed on the ASC-CPL; allowing ASCs to compliantly perform these procedures and be appropriately reimbursed. With the changing of administrations, the CY 2022 final ruling dealt a reversal of many of the key provisions of the previous year, including the removal of spine codes just recently added from the ASC-CPL, with some even being put back on the in-patient only list (IPO). 

These dramatic policy changes impacting spine and other specialty types, can leave ASCs vulnerable to loss of potential patient volume, coding errors, and revenue cycle challenges that can impact potential revenue.  As such, now is the time to review key processes and areas of operation.   

Front-end Operations

ASC’s have not been immune to staffing shortages, leaving critical functions unfulfilled and impacting profitability.   Now is the right time to review and apply industry best-practices to common front-end processes ensuring clean claims and improved cash.   

  • Patient demographics drive claim accuracy and insurance verification ensures that the patient’s coverage is...(More)

For more info please read, The Impact of 2022’s Policy Changes on Your ASC’s Spine Program, by Becker's Spine Review

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