Medicare payment system for ambulatory surgical centers

Area of Science:

• Healthcare Reimbursement
• Health Economics
• Surgical Center Operations

Background:

• Ambulatory Surgical Centers (ASCs) operate under a defined payment system.
• Current reimbursement is based on a fee schedule covering eight service cost categories.
• This schedule undergoes annual adjustments for geographic wage variations.

Purpose of the Study:

• To outline the current payment structure for Ambulatory Surgical Centers.
• To identify key components of the existing fee schedule.
• To highlight anticipated future changes in the ASC payment system.

Main Methods:

• Analysis of the current Ambulatory Surgical Center fee schedule.
• Examination of geographic wage adjustment factors.
• Review of planned modifications to the prospective payment system (PPS).

Main Results:

• ASCs are compensated via a fee schedule across eight distinct service cost categories.
• The fee schedule incorporates geographic wage adjustments and is subject to annual updates.
• Future adjustments are planned to shift the ASC PPS towards resource-based rates.

Conclusions:

• The current ASC payment model relies on an annually updated, geographically adjusted fee schedule.
• The prospective payment system (PPS) for ASCs is evolving.
• A transition to resource-based rates is anticipated for future ASC reimbursement.