Magazine article Medical Economics

Answers to Your Questions about . .

Magazine article Medical Economics

Answers to Your Questions about . .

Article excerpt

Changes to the ASC payment system

Our group owns an ambulatory surgery center. We heard that Medicare changed the ASC payment system effective Jan. 1, as well as the list of ASC-approved procedures. Will these changes affect our bottom line?

Probably. The ASC facility payment will be equal to about 65 percent of what Medicare pays a hospital for the same procedure performed in its outpatient department. And now, just as in the hospital, CCI edits and multiple procedure reductions will apply to ASC services. So the order of the procedures submitted on the claim form will affect your overall compensation; you'll receive 100 percent of the allowable charges for the first procedure and 50 percent for every one thereafter.

Even though almost 800 new procedures have been added to the ASC list, payment is capped for procedures historically done more than 50 percent of the time in a physician's office to the lower of the ASC rate or the nonfaciliry practice expense under the Medicare Physician Fee Schedule. So reimbursement for the hundreds of procedures diat are subject to this cap may be too low to justify performing them in an ASC.

Numerous other issues affect the reimbursement process, so it's best to evaluate each procedure you plan to do and weigh the costs associated with providing it in an ASC setting against the revenue generated. Monitor your specialty societies for reimbursement information concerning the procedures you typically perform.

Low reimbursement for injectables

Much as I don't wish to, I may have to stop providing my patients with injections. The reimbursement doesn't cover the cost of the drug, much less the cost to administer it. Any tips on how to deal with this problem?

First, make certain you're reporting the correct units of service for the drugs you administer. J codes-used to identify the medicine you inject-come in units, and you may need to charge for more than one unit to fully cover an injection. …

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