ASCs Can Provide Hospital Services Under the Emergency COVID-19 Blanket Waivers

On March 30, 2020, CMS implemented emergency regulatory changes that provide ASCs with the flexibility to perform hospital services to help the US healthcare system manage the expected surge of COVID-19 patients.

The implementation of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers includes waivers for all providers. Specifically, it allows ASCs to:

• Enroll and bill for services as a hospital.
• Contract with local hospitals and health systems to provide hospital-based services, effectively becoming a temporary hospital outpatient department.

In addition, the waiver allows hospitals to expand their service locations and to change the status of their current provider-based department (see page 7 of the waiver, “Temporary Expansion Locations”), which includes an ASC enrolling as a hospital during the period of the Public Health Emergency (PHE).

ASC Hospital Enrollment and Contracts for Provision of Hospital Services

ASCs can enroll by calling their COVID-19 Medicare provider enrollment hotline for the Medicare Administrative Contractor that serves their geographic area. Click here for additional information on hotlines.

ASCs can contract directly with a hospital as a subcontractor. As a subcontracted entity, the ASC can provide services to patients as a department of the hospital.

• These services may include, but are not be limited to:
  • Emergent/urgent surgical services.
  • Urgent care services.
  • Overnight bed capacity for low-acuity patients (non–COVID-19).
  • Birthing services.
  • Triage and call center.
  • Clinical and nonclinical staff support.
• The ASC will bill the hospital for the contracted services.
• The ASC will be paid for services based on the terms agreed upon in the contract with the hospital.

With respect to coding, billing, and reimbursement for services rendered on behalf of the hospital, ASC leaders need to be aware of several key items, which differ for those ASCs enrolled as a hospital versus those under contract with a hospital.

For ASCs enrolled as a hospital under the PHE:

• Comply with Medicare claims and billing requirements (click here and see page 23, under “Claims Submissions for Blanket Waivers”).
• Establish charges for provision of hospital services.
• Contact commercial payers to notify them of the change in status as a hospital under the waiver and to confirm the ASC is enrolled in Medicare as a hospital under the PHE.
• Establish reimbursement rates for new services with commercial carriers as a hospital if not covered under existing commercial payer contracts.
• Establish payment rates and utilize methodologies that allow for ease in attaining an amendment or execution of a contract in an expeditious manner. Consider the following structures:
  • Discount off of charges
  • Per diems
  • Fee schedule or flat rates
  • Percentage of hospital Medicare

For ASCs under contract with the hospitals:

• Establish mutually agreed-upon payment rates and a methodology with the hospital that will be incorporated into the contract between the ASC and the hospital (see checklist below for additional information).
• Determine if electronic billing capabilities are available while the ASC is operating as a hospital, or manual billing may be necessary.
• Understand the implications for patient billing and whether patients will see increased charges as the ASC operates as a department of the hospital.

ASC Checklist

The following is a checklist that ASC leaders should consider when enrolled and operating as a hospital, or as the ASC enters into a contractual arrangement with a hospital or health system to provide hospital services:

• Review state rules or regulations that may impact the ASC’s ability to provide services under the blanket waivers.
• Confirm there are no state emergency preparedness or pandemic rules that will prohibit the ASC from providing hospital services under the federal regulatory changes.
• Confirm the services to be provided by the ASC.
• Ensure that physicians or providers who come from the hospital to the ASC are credentialed.
• Verify malpractice and general liability insurance coverage and any requirements of your insurance company for providing hospital services.
• If the ASC is contracted with the hospital, determine whether the hospital has liability insurance coverage that will cover the ASC as a hospital department under a subcontract arrangement.
• Establish any processes that may need to be implemented for medical records if the ASC is contracted with the hospital as a department.
• Contact your IT vendor to see whether they can support the hospital billing process and help the ASC implement any modifications.
• Establish a process for coding, billing, and collecting for services rendered as a hospital.
• Determine a payment rate and structure that can be administered with ease between the ASC and the hospital. Some options may include, but are not limited to:
  • Per diems.
  • Flat rates per case or per patient.
  • Fee schedule per service.
• Develop a mutually agreeable process for scheduling cases that are being transferred from the hospital to the ASC.
• Create a supply chain management/procurement process to ensure correct supplies are on hand for hospital cases or new services.
• Ensure there is the appropriate staffing and skills for any new services to be provided by the ASC.
• Train ASC staff as needed to support new services or surgical specialties.

This is not intended to be an exhaustive checklist and may vary by ASC and each situation.

ECG’s COVID-19 thought leadership page is being updated frequently, so check back often for expert advice. If you need immediate help, contact us with your questions and concerns.