Issue link: https://beckershealthcare.uberflip.com/i/640044
43 Coding & Billing "Our patients are enjoying the fact that they know the total cost of surgery and they only have to write one check," says Gabby White, RN, of Newport Beach, Calif.-based Orthopedic Surgery Center of Orange County, a direct subsidiary of Irvine, Calif.-based Hoag Orthopedic Institute. e Orthopedic Surgery Center of Orange County is a frontrunner in price transparency, list- ing all-inclusive prices for 54 procedures. Ms. White's surgery center labels this cash transparent pricing as "global" pricing on its website. is term is synonymous with bundled pricing. ASCs are poised for a head start in executing price transparency, as they know their real costs. Employing price transparency Price transparency relies on accuracy, so ASCs should start the process small. "Choose procedures that are fairly predictable, with not a lot of variation of time in the OR, supplies or implants used," says Ms. White. Before publishing an all-inclusive cost for an open rotator cuff repair on an ASC's website, for example, administrators must know the actual true costs of the pro- cedure. Once the price is on the website for patients to see, recoiling from the cited price later isn't an option — the ASC will sever the trust with patients. "You'll lose the whole program," says Ms. White. Some procedures have un- predictable prices, however. In those cases, surgery centers can list a "starting price" or an "average price" and discuss the potential for price increases on an individual patient basis. To avoid this faux-pas, look at the spe- cific procedure's costs as a whole instead of following a typical insurance-payment process of breaking costs down by indi- vidual CPT codes. e next step involves persuading the center's physicians to get on board, and provide accurate rates for the specific pro- cedures. en, apply a margin for wiggle room in case an atypical event arises in a particular case. is final rate is the "glob- al" cash or bundled rate for the procedure. Ms. White warns about physicians using an additional implant during the procedure or some other extra cost that will hike up the procedure rate. An ASC's administrative office and operating room must be in clear, open com- munication to execute price transparency. "It's a change for everybody. ere has to be a very trusting professional relationship," says Ms. White. She recommends implementing price trans- parency gradually rather than all at once. Dealing with payer complications An ASC's "global" cash rates may raise payers' suspicions about true costs of procedures. Since Ms. White's surgery center estimates the cost of a proce- dure as a whole instead of nickel-and-diming every CPT code, some of the "global" cash rates may be less than the commer- cial reimbursement rates. "Payers may see that result and say, why are you charging less for the procedures than what we pay you?" explains Ms. White. However, because the prices listed represent all-inclusive rates, payers do not know who receives what amount of money. Some patients who opted for the "global" cash rate may at- tempt to pay with insurance. is presents a problem, as the ASC cannot accept insurance for a procedure at the bundled price outside of the insurance company's contracted rates. Overemphasize the conditions of using the "global" transpar- ent rate to the patient, pre-surgery. Striding ahead with transparency Price transparency provides an ASC with predictable pricing that eases financial disagreements for both the surgery center and patients. "Patients know upfront what they're getting." It may prove challenging for hospitals to put all the rates into one pot, as all entities want to know who's paying the money. Surgery centers have "a lot more trust between the surgery center and doctor's office," says Ms. White. Ms. White sees price transparency as a tool for surgery centers to advance value-drive care. "I think it gives you a competitive edge in your community, because the community knows you're putting your prices out there," says Ms. White. "ey see that as a trustworthy move, put- ting yourself behind your work and the prices you're offering." n Putting It All Out There — Price Transparency in ASCs (continued from cover) Gabby White 5 Notes on CPT Code Changes for Anesthesia & Pain Management By Anuja Vaidya T here were no changes made to anesthesia CPT codes for 2016, how- ever, there were changes made affecting pain management services and ASA 2016 CROSSWALK, according to an Anesthesia Business Consultants blog post. Here are five notes: 1. Some changes for pain management providers to take note of include new paravertebral block/catheter codes along with additional bundling of imaging guidance with base CPT codes. 2. Additional parenthetical guidelines have been added for destruction codes (64633 to 64636). 3. Medicare also revised epidural steroid injections 62310, 62311, 62318 and 62319. 4. In addition, there were revisions to the ASA 2016 CROSSWALK. These changes include CPT to ASA cross changes as well as alternative ASA code changes. 5. Due to these ASA 2016 CROSSWALK changes, the base unit values for services have been increased or decreased based on the change itself. n