Becker's Healthcare July 29, 2024
Cardiology-specific ASCs are faced with new challenges as payers update policies amid these high-acuity procedures’ migration to the outpatient setting.
Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker’s the biggest payer issue his ASC is facing is “denials that do not fall in line with the Medicare payable procedures.”
Many private payers aren’t matching Medicare codes for cardiology procedures, Mr. Helmer said, “for example, loop recorder implants are commonly denied for no prior authorization from private payers, yet, in the Medicare fee schedule, they require no authorization and there’s usually not a problem.”
“It feels incongruent for sure,” he said. “It’s also frustrating to think that you’ve got all of your I’s dotted and T’s...
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