ASC Focus: Beat the Pain Management Payment Crunch

Efficiency and a diverse caseload are the best coping strategies
With many commentators predicting doom and gloom for ASCs receiving APC payments for pain management services, panic might seem to be a reasonable response. But a full understanding of how APC methodology affects pain management payment suggests that the best-prepared ASCs will actually fare better under the new system. Here’s what you need to know to make your facility a winner.

Appreciate the Big Picture

Under the APC payment system, ASCs that provide pain management services will have more -- and more reliable -- billing opportunities, even as payments for some common pain management services have fallen, says Amy G. Mowles, president of Mowles Medical Practice Management LLC.
The background: This past January, CMS began basing its ASC payment rates on the APCs used to value procedures under the outpatient prospective payment system (OPPS). To reflect the lower costs of freestanding ASCs versus hospitals, CMS has limited ASC reimbursement for APCs to about 65 percent of hospital outpatient rates, says Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.
In some cases, the 65 percent APC rate for ASCs falls short of previous payments. For instance, the most commonly reported pain management procedures (such as epidural and facet joint injections) have seen payment reductions of about 20 percent for 2008, says the American Society of Interventional Pain Physicians (ASIPP).
CMS will phase in the new payment rates over four years, with total implementation in 2011. For procedures with falling reimbursement in 2008, future years may exacerbate the problem. ASIPP predicts up to a 40 percent reduction in reimbursement for common pain management procedures by 2010.
Here’s the good news: Some procedures, such as neurolytics, actually reimburse better under APCs because the previous payment system did not account for the costs of expensive needles, probes and grounding pads, Mowles says. As a second example, APCs provide a "device percentage" to pay for stimulators and pumps -- for which you previously had to engage in extended negotiations and compromise to gain payment.
"In addition, APCs allow payment for a greater range of services than the previous method," Mowles says. "In the past, if you provided an ‘off list’ service, you were supposed to bill the physician directly for your facility fee, but often this didn’t happen. Under APCs, payment for more services, such as nerve blocks, is automatic."
"With the greater number of directly billable procedures, plus improved reimbursement for the more- expensive-to-provide services, 2008 has been the best year so far for pain management ASCs," Mowles says. And with the possibility of [...]

- Published on 2008-06-12