Fix ASC Billing Margins to Protect Surgical Revenue

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Fix ASC Billing Margins to Restore Financial Stability Ambulatory Surgery Centers (ASCs) are under increasing financial pressure. Rising supply costs, staffing challenges, payer reimbursement cuts, and complex billing rules are steadily shrinking profitability. When billing inefficiencies exist, even high surgical volume cannot protect ASC billing margins. Fixing ASC billing margins requires more than increasing case volume. It demands accurate coding, clean claims, payer compliance, and a disciplined revenue cycle strategy. Without these elements in place, revenue leakage becomes inevitable. Why ASC Billing Margins Are Declining ASC billing margins are declining across the U.S. healthcare system due to a combination of operational and reimbursement-related factors. Many of these issues remain hidden until cash flow is already impacted. Key contributors include: Underreported procedures and implants Incorrect CPT, HCPCS, and modifier usage Missed or delayed pre-authorizations ...
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Skilled Nursing Facility 3- Day Rule Waiver

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CMS is waiving the requirement at Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF 3- Day Rule Waiver) stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who need to be transferred as a result of the effect of a disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period. Second, CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission.

Background

Under the Shared Savings Program, the Centers for Medicare & Medicaid Services (CMS) enters into a participation agreement with each participating Accountable Care Organization (ACO). CMS will reward eligible ACOs when they lower growth in Medicare Parts A and B fee-for-service (FFS) costs (relative to their ACO-specific benchmark) if, at the same time, they meet performance standards on quality of care.

The SNF 3-Day Rule Waiver waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered, post-hospital, extended-care service for eligible beneficiaries. Only Shared Savings Program ACOs that are currently participating in, or applying to, certain Shared Savings Program performance-based risk tracks have the opportunity to apply for a waiver of the SNF 3-Day Rule, and they must apply separately for the waiver during the annual application process.

Read more regarding Skilled Nursing Facility 3- Day Rule Waiver: https://bit.ly/3e5qNev. also you can get in touch with us at info@medicalbillersandcoders.com or call us at 888-357-3226.

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