Becker's ASC Review

16 ASC MANAGEMENT New reasons insurers are denying payment By Laura Dyrda C ommercial insurers are changing their policies to deny hospitals and ASCs payment for services deemed unnecessary or lacking enough evidence to move forward. In the last few years, such companies as Empire BlueCross BlueShield in New York; Anthem; and UnitedHealth Group have been directing outpatient procedures to ASCs. In some states, insurers have stopped paying hospitals for outpatient procedures. UnitedHealthcare will begin denying emer- gency department claims for services that it doesn't consider emergencies when the pandemic ends. e company origi- nally planned to implement the new policy July 1, but then delayed the change June 10, according to the StarTribune. When Anthem had a similar policy, the payer denied 12,000 claims in three states during a six-month period in 2017. American Hospital Association CEO Rick Pollack criticized UnitedHealthcare's policy in a June 8 letter to UnitedHealth- care CEO Brian ompson and requested the company reverse the policy. e American College of Emergency Physicians also came down against the policy. While ASCs don't typically provide emergency services, executives noticed stricter policies for preauthorizations and service denials. Tammy Stanfield, BSN, RN, administrator and director of nursing at Conroe, Texas-based North Pines Surgery Center, said an increase in the number of pending authorizations from insurance companies or more frequent denials could break the center. Taylor Cera, COO of Orthopaedic Surgery Center in Youngstown, Ohio, said he constantly reviews payer con- tracts and communicates with contract managers to avoid missing a policy change that could hurt his centers. "We've already seen some new trends and new rules from insurance companies, specifically regarding preauthoriza- tions in orthopedics," he said. "It has caused some issues in our flows and our processes, so I think continuously having those conversations and understanding things that are com- ing down the pipeline that are going to affect our internal processes is extremely important to know." Andrew Bush, MD, an orthopedic surgeon at Central Caro- lina Orthopaedics Associates in Pittsboro, N.C., also noticed a trend of insurance companies more routinely denying diagnostic tests and requesting more peer reviews. "We recently had a Blue Cross Blue Shield policy deny a surgical knee arthroscopy due to something like lack of sufficient evidence, but be willing to authorize the surgery if I agreed to make it a diagnostic arthroscopy, which would cut my reimbursement in half," he told Becker's. "I refused BCBS for obvious reasons. e patient ended up paying out of pocket for the case, and I ended up doing the surgery I initially indicated." n Employed vs. independent physician pay for 7 ASC specialties By Laura Dyrda I ndependent physicians report higher average compensation for the specialties most essential to ASCs, according to the Med- scape Physician Compensa- tion Report 2021. The report, released May 14, shows the gap between compensation for employed specialists and indepen- dent specialists ranges from $3,000 in gastroenterology to $32,000 among OB-GYN physicians. Here is a breakdown of seven ASC specialties: 1. Orthopedic surgeons Employed: $497,000 Independent: $526,000 2. Cardiologists Employed: $450,000 Independent: $477,000 3. Gastroenterologists Employed: $405,000 Independent: $408,000 4. General surgeons Employed: $371,000 Independent: $379,000 5. Anesthesiologists Employed: $367,000 Independent: $391,000 6. Ophthalmologists Employed: $361,000 Independent: $395,000 7. OB-GYN physicians Employed: $300,000 Independent: $332,000 n 6 deals with ASCs costing more than $10M By Carly Behm H ere are six medical office building deals including ASCs that cost at least $10 million announced this year: 1. Phoenix-based OrthoArizona sold its medical office building and ASC real estate in a $23.6 million transaction facilitated by Fairfield Advisors. 2. White Oak Healthcare made its first acquisition in Nevada, a medical office building in Henderson, for $18.8 million. The building houses Coronado Medical and Surgery Center. 3. The building housing Southeast Eye Specialists in East Brain- erd, Tenn., sold for $14.3 million. 4. La Salle Investment Management acquired a Beverly Hills, Calif., medical office building with ASC for $74.4 million. 5. A medical office building housing a surgery center and ur- gent care clinic in Burnsville, Minn., sold for $52 million. 6. Nashville, Tenn.-based Montecito Medical Real Estate acquired a medical office property in Richmond, Va., for $32.5 million. n

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