D E C E M B E R 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 2 3
The Absurdity of the ASC Payment System
Why does Medicare pay surgical centers 50% of what hospitals receive?
I
get asked all the
time to explain
how Medicare
sets the payment
rates for ambulatory
surgical centers.
That's a really tough
task, but here are
answers to 5 com-
mon questions about
CMS policies that
just don't make a
whole lot of sense.
Why are ASCs
reimbursed so
much lower than
HOPDs?
In 2008, when the Centers for Medicare & Medicaid Services (CMS)
introduced the system that it uses to set ASC payment rates today,
ASCs were reimbursed about 65% of what HOPDs receive for provid-
ing the same surgical services. The rationale: ASCs lack much of the
overhead associated with running a hospital, such as maintaining an
emergency room and being open 24/7. Over the years, however, the
payment disparity has widened: about 53% in 2016 and about 50% for
2017. The culprits?
• OPPS. When CMS began paying for facility services provided in
ASCs — such as nursing, recovery care, anesthetics, drugs and other
1
Coding & Billing
Kara Newbury, JD
Pamela
Bevelhymer,
RN,
BSN
• HEAD-SCRATCHER Good luck trying to figure out the rationale behind Medicare's ASC
payment policy.
