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Obamacare, You're Fired - December 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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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.

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