ASC RCM Quick Tips: Address Sequestration Suspension in Contracts
By Angela Mattioda, Vice President of Revenue Cycle Management Services
UPDATE: The suspension of Medicare sequestration has officially been extended through the end of 2021. Learn more here.
In April 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act temporarily suspended the 2% payment adjustment applied to all Medicare fee-for-service (FFS) claims due to sequestration. This was intended to help providers, including ASCs, navigate the challenges of COVID-19. At this time (February 2021), the sequestration has been suspended through the end of March 2021. I expect it will be further suspended since we are still in the midst of the public health emergency. The Ambulatory Surgery Center Association has asked Congress to extend the moratorium on these Medicare reimbursement cuts for as long as the COVID-19 health crisis continues.
Unfortunately, I have seen many ASCs still loading contracts with the sequestration included. In such scenarios, payment posting staff are not alerted if the discount is applied. This essentially translates into an unnecessary 2% loss on affected contracts, which may include Medicare, Medicare Advantage, and other managed care plans. A 2% decrease can add up quickly over time.
Check to ensure you have the proper contracts loaded. If you do not, update your contracts immediately and audit payments to determine whether you received 100% of affected payments, not 98%. For those payments that include the reduction, determine if you can appeal. For Medicare, you can go back a year from the date of service if something like this was missed. For other payers, you might only have a window of 90 days.
