How the CMS Final Rule will Affect Orthopedic ASCs: 5 Key Notes
On Nov. 2, CMS received the 2018 final payment rule, providing a 1.2 percent increase in ASC reimbursement next year. The final rule also addressed several issues pertaining to orthopedic procedures in ASCs, including total joint replacements and spine procedures.nnHere are five ways the final rule will affect orthopedic ASCs, according to guidance from ASCA:n
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- Total knee replacements: CMS removed total knee replacement from the inpatient only list, but did not add it to the ASC payable list. The agency will continue discussion on other joint replacement codes before removing them from the inpatient only list as well. While some in the industry are excited by this move, which could bring total knee replacements a step closer to the ASC payable list, others feel it could have a negative impact on an ASC’s ability to negotiate fair contracts with private payers if CMS sets the rate too low.
- Total and partial hip replacements: In the proposed final rule, CMS solicited comments for adding total and partial hip replacements to the ASC payable list, but decided not to add them in the final rule, stating, “Our understanding is that these procedures typically require more than 24 hours of active medical care following the procedure.”
- Spine surgery: CMS added two spine procedures to the ASC payable list, including total disc arthroplasty with discectomy (22856) and second-level cervical disc arthroplasty with discectomy (22858).
- Quality reporting: A new quality measure was approved that will affect orthopedic surgery centers specifically: ASC-17 will collect data via claims for hospital visits after orthopedic procedures in the ASC. Data collected over the next few years will affect payment determination in 2022 and subsequent years.
- Payment rates: Overall, ASCs received a 1.2 percent reimbursement increase and hospital outpatient departments received a 1.35 percent increase.
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nTo learn more about orthopedic-driven ASC reimbursement and what to expect from CMS in the future, attend the Becker’s 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference June 14-16, 2018 in Chicago. Click here to learn more and click here to register.nnThis article wasvoriginally posted on beckersasc.com.
All of us at Welter Healthcare Partners, would like to wish our clients, families and friends a Happy Thanksgiving! We are grateful for the relationships we have formed and for your continued to support of Welter Healthcare Partners. In observance of the holiday, we will be closed on 
Decision-making in its most basic form is the act of choosing between two or more courses of action. Each and every person in the world is faced with the decision-making process on a daily basis – whether it’s trivial things like deciding what is for dinner or which route to take to work or more serious life-changing decisions like what your next career move should be or which home is the best long-term investment for your family. To be effective in the decision-making process, it is imperative to avoid impulsive behavior and really think each scenario through. This can be done via pros/cons list, intuition, and/or reasoning. All methods have both advantages and disadvantages. Regardless of the method(s) chosen, avoid the following problems that can hinder effective decision-making: not having enough information to see the big picture, having too much information and going down the path of “analysis paralysis”, having too many hands in the pot, vested interests, emotional attachments, and having no emotional attachment. Being effective in the decision-making process is key to future success!
On November 2, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after 
Unfortunately, many healthcare providers are missing out on things like electronic billing, email capture.nnA new survey by the Medical Group Management Association suggests providers, especially hospitals, are missing out on key areas to improve when it comes to patient billing, payments and satisfaction.nnThe Digital Payments Progress report, a product of a partnership with medical claims management company Navicure, is a national survey conducted among MGMA member organization this past May.nnThe report shows that physician practices seem to have the advantage when it comes to billing and payments. For instance, 79 percent of ambulatory organization respondents can generate a cost estimate upon request, while only 69 percent of hospital respondents can do so.nnAlso, 64 percent of group practice respondents reported patients are comfortable sharing their email address, while only 56 percent of hospital respondents had that perception.n“In actuality, 79 percent of patients report feeling comfortable providing their email address. This represents an opportunity to leverage email addresses to deliver bills electronically, saving the industry millions of dollars in cost, environmental waste and days in A/R,” the report said.nnThere are also other key areas where all providers could be doing a better job of playing to the needs and wants of consumers. Despite a majority of patients’ preference for electronic billing, 52 percent specifically, 77 percent of respondents still send paper bills. A similar study conducted in January by Navicure and Himss Analytics showed the same trend, with 52 percent of patients preferring electronic billing but 89 percent of providers saying they still used regular mail.nnThe HIMSS/Navicure study also showed keeping a credit card on file is something that 78 percent of patients approve of for small charges totaling less than $200 but only 20 percent of providers used this method.nnThe Progress Report echoed this notion, with results showing CCOF would be highly beneficial to revenue cycle management, and ultimately a provider’s bottom line. It helped reduce patient bad debt/write off, according to 36 percent of respondents, and 34 percent said it cut days in patient A/R and cost of collections, the report said.nnIn an age of consumerism, where patients are paying more out-of-pocket costs and shopping around for providers and services, practices and hospitals alike would do well to pay attention to these trends among patients, who now act more like retail consumers who go where their needs and preferences are met. Consumers have voiced a willingness to switch providers in order to have services like telehealth available to them. Chances are, as they become even more discerning and demanding, something seemingly small like electronic billing could prove pivotal when it comes to keeping patients’ business.nnThis 
MI code updatesnnThe list of ICD-10 code updates is extensive and Myocardial Infarctions got a makeover with this year’s revision. Code category I21 has been renamed from “ST elevation and non-ST elevation myocardial infarction” to “Acute myocardial infarction”. Additional specificity options now include type 1, type 2, and other MI types. Providers will need to specify in clinical documentation the type of MI the patient experienced. STEMI codes (I21.0 and I21.1) are now defined as Type 1 MIs. New codes I21.A1 – MI type 2 and I21.A9 – other MI type are also important and notable additions.