Coding Cues: Changes to the ASC payment system

February 15, 2008

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?

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 nonfacility practice expense under the Medicare Physician Fee Schedule. So reimbursement for the hundreds of procedures that are subject to this cap may be too low to justify performing them in an ASC.