Part 1B:
Based on the physician reimbursements for several CPT codes on physician lookup function on CMS, there is a variation in Medicare payments that are provided at facility setting (inpatient, outpatient or ambulatory) to that of a non-facility setting (physician’s office). In most cases, the Medicare’s non-facility pricing is higher than the facility pricing; this difference in payments accounts for three aspects which are categorized into Relative Value Units (RVUs) under physician’s current procedural terminology (CPT) codes attributed. Components of RVUs that determine the amount paid for each procedure are Physician Work, Practice Expense and Practice Liability Expense/ malpractice expense. Taking cost involved to the provider for …show more content…
ASCs provide services and procedures in a convenient and safe manner outside the hospital setting with greatest benefit being the providing services on an outpatient basis, thus reducing the challenges encountered in inpatient facilities such as scheduling delays, limited operating room availability, slow operating room turnover, etc. and with significant cost-savings for procedures when compared to procedures provided in a hospital setting. Development of Ambulatory Surgical Center initiative is developed by two physicians in 1970s, who envisioned the opportunities to establish high quality, cost effective care alternative to inpatient hospital care for surgical procedures. Data suggest that almost 40% of outpatient surgeries are performed at Ambulatory Surgical Centers, comprises of more 5,000 ASCs with benefits in the form of savings opportunities that includes 56% saving for beneficiaries, reduced copays for patients and 41% savings to Medicare by providing services at lower costs than to Hospital Outpatient Departments (HOPDs). (2) For receiving Medicare payments, ASCs should be certified and are required to meet certain specific requirements mandated by Centers for Medicare and Medicaid (CMS) that emphasize the quality and safety of patients by …show more content…
This revised version of ASC payment system, excludes the previous measure of evaluating the geographic difference wage index through Metropolitan Statistical Area (MSA), instead replaces with the Core Based Statistical Area (CBSA) geographic locality definitions to make payment adjustments. For each separately payable procedure, CMS uses ASC relative payment weight for each procedure which are based on Outpatient Prospective Payment System (OPPS) relative payment weights and multiplying with ASC conversion factor determined through other various measures. Based on the adjustments considering the geographic wage index differences and ASC conversion factor for calendar year 2008, CMS has estimated that ASCs receives payments of up to 65% for each procedure of OPPS payment rates for the same surgical procedures performed at an ambulatory surgical center.
Based on the physician reimbursements for several CPT codes on physician lookup function on CMS, there is a variation in Medicare payments that are provided at facility setting (inpatient, outpatient or ambulatory) to that of a non-facility setting (physician’s office). In most cases, the Medicare’s non-facility pricing is higher than the facility pricing; this difference in payments accounts for three aspects which are categorized into Relative Value Units (RVUs) under physician’s current procedural terminology (CPT) codes attributed. Components of RVUs that determine the amount paid for each procedure are Physician Work, Practice Expense and Practice Liability Expense/ malpractice expense. Taking cost involved to the provider for …show more content…
ASCs provide services and procedures in a convenient and safe manner outside the hospital setting with greatest benefit being the providing services on an outpatient basis, thus reducing the challenges encountered in inpatient facilities such as scheduling delays, limited operating room availability, slow operating room turnover, etc. and with significant cost-savings for procedures when compared to procedures provided in a hospital setting. Development of Ambulatory Surgical Center initiative is developed by two physicians in 1970s, who envisioned the opportunities to establish high quality, cost effective care alternative to inpatient hospital care for surgical procedures. Data suggest that almost 40% of outpatient surgeries are performed at Ambulatory Surgical Centers, comprises of more 5,000 ASCs with benefits in the form of savings opportunities that includes 56% saving for beneficiaries, reduced copays for patients and 41% savings to Medicare by providing services at lower costs than to Hospital Outpatient Departments (HOPDs). (2) For receiving Medicare payments, ASCs should be certified and are required to meet certain specific requirements mandated by Centers for Medicare and Medicaid (CMS) that emphasize the quality and safety of patients by …show more content…
This revised version of ASC payment system, excludes the previous measure of evaluating the geographic difference wage index through Metropolitan Statistical Area (MSA), instead replaces with the Core Based Statistical Area (CBSA) geographic locality definitions to make payment adjustments. For each separately payable procedure, CMS uses ASC relative payment weight for each procedure which are based on Outpatient Prospective Payment System (OPPS) relative payment weights and multiplying with ASC conversion factor determined through other various measures. Based on the adjustments considering the geographic wage index differences and ASC conversion factor for calendar year 2008, CMS has estimated that ASCs receives payments of up to 65% for each procedure of OPPS payment rates for the same surgical procedures performed at an ambulatory surgical center.