- Joined
- May 2, 2005
- Messages
- 148
- Reaction score
- 0
How do the different levels of facility fee work? I see that there are 1 through 9 levels of fees from medicare fee schedule. Do you need an anesthesiologist on staff to get ASC rating with Medicare?
Charges for facility fee
- Thread starter C Fiber
- Start date
- Joined
- May 3, 2005
- Messages
- 4,238
- Reaction score
- 2,293
All pain injections are a level 1. Anesthesiologists are not required for an ASC, but the size of the ASC OR is determined whether local cases, MAC cases, or general cases are to be performed there.
- Joined
- May 3, 2005
- Messages
- 4,238
- Reaction score
- 2,293
There is legislation swirling about that primarily involves specialized surgical hospitals that are sucking the blood from the traditional hospitals. There has been discussion on including ASCs in such legislation, but at this time, ASCs are not included...
Algos....any chance that the hospitals being affected have many powerful lobbyists on their side? I think that because hospitals are charging about twice the price for the same procedure an ASC charges may be a reason. Of course, doing the exact same procedure in your office is alot cheaper than an ASC also, which is kind of the same principle, but less of a "political" issue. I just found it funny when i was at the ASC today that the office manager was giving me some useful information and that was one of the tidbits i learned.
T
T
- Joined
- May 3, 2005
- Messages
- 4,238
- Reaction score
- 2,293
The AHA has lobbied very hard against specialty hospitals and probably for good reason. A doctor owned specialty hospital here in Indiana now takes all paying orthopedic cases to their hospital while leaving the Medicaid and self pay emergency patients at the traditional hospitals. Also the specialty hospital does not have an emergency department therefore does not see the parade of non paying patients seen in traditional hospitals.
Because of regulation of procedures performed, most hospitals will not veer far from the Greely Associates "White Paper" documents on what is permitted by different specialties. This places hospitals hopelessly behind the times as the Greely documents are often 2-5 years out of date, and often do not consider pain management advances. Hospitals therefore are often not friendly to new procedures by pain docs unless the White Papers say it is ok.
ASCs may be less rigid, but this depends on whether they are credentialled or not. An ASC with AAAHC credentialing or JCAHO credentialing is just as rigid as a traditional hospital in what procedures may be offered. Non-credentialed hospitals or those credentialed by agencies that do not require the physician have the same privileges for a procedure in a hospital are more physician friendly.
Office practices are largely unregulated unless a physician is so unsophisticated as to have JCAHO credential their office practice. But the facility fee is not available in offices, nor is there an equipment pass through cost available. So it is a trade off....some procedures, such as dekompressor, cannot be performed for Medicare patients and also many insured patients due to the high cost of the disposable equipment.
Because of regulation of procedures performed, most hospitals will not veer far from the Greely Associates "White Paper" documents on what is permitted by different specialties. This places hospitals hopelessly behind the times as the Greely documents are often 2-5 years out of date, and often do not consider pain management advances. Hospitals therefore are often not friendly to new procedures by pain docs unless the White Papers say it is ok.
ASCs may be less rigid, but this depends on whether they are credentialled or not. An ASC with AAAHC credentialing or JCAHO credentialing is just as rigid as a traditional hospital in what procedures may be offered. Non-credentialed hospitals or those credentialed by agencies that do not require the physician have the same privileges for a procedure in a hospital are more physician friendly.
Office practices are largely unregulated unless a physician is so unsophisticated as to have JCAHO credential their office practice. But the facility fee is not available in offices, nor is there an equipment pass through cost available. So it is a trade off....some procedures, such as dekompressor, cannot be performed for Medicare patients and also many insured patients due to the high cost of the disposable equipment.
- Joined
- May 2, 2005
- Messages
- 148
- Reaction score
- 0
With Medicare's $333 facility fee per case, 2-3 RFK needles costing $70-110, sterilizing fee, RF machine, nursing cost, etc.....why does anyone want to spend the energy and time to get ASC certification?
What goes into a ASC certification anyways? Sorry to sound stupid, but what's JCAHO and AAAHC's role in certifying ASCs? I thought the Center for Medicare Services certify ASCs??????
What goes into a ASC certification anyways? Sorry to sound stupid, but what's JCAHO and AAAHC's role in certifying ASCs? I thought the Center for Medicare Services certify ASCs??????
- Joined
- May 3, 2005
- Messages
- 4,238
- Reaction score
- 2,293
CMS does certify ASCs but that may not be enough for insurance carriers that require a higher standard. There are actually 3 other certifying agencies for ASCs. Part of the issue is insurance driven but part is the indefatiguable drive of nursing administrators to use certification as a means of self adulation. It is similar to the absurd amount of weight placed on patient satisfaction scores taken by hospitals....no one really cares about these numbers except hospital administrations, who care deeply about them. Similarly, ASC certification has little meaning to patients or doctors, but administration perceives they do, and uses this certification in marketing to patients who don't give a flip about certification.
On the ISIS board we recently calculated the cost of doing a procedure in an ASC and in an office. Our office costs are about $70 per procedure and that includes space, fluoro, table, collection fees, staff, etc. In an ASC the same procedure costs close to $250. Therefore even factoring in the facility fee, Medicare cases (pay 3 times the physician fee when performed in an office) and some insurers (Anthem, Wellpoint) would be better off performed in an office setting.
On the ISIS board we recently calculated the cost of doing a procedure in an ASC and in an office. Our office costs are about $70 per procedure and that includes space, fluoro, table, collection fees, staff, etc. In an ASC the same procedure costs close to $250. Therefore even factoring in the facility fee, Medicare cases (pay 3 times the physician fee when performed in an office) and some insurers (Anthem, Wellpoint) would be better off performed in an office setting.
- Joined
- Sep 13, 2003
- Messages
- 470
- Reaction score
- 1
$333 per case? It was my understanding that it was $333 per procedure. It doesn't seem right that a single level transforaminal ESI would be reimbursed the same amount as a 5 level medial branch RF.
- Joined
- Jun 1, 2005
- Messages
- 3,861
- Reaction score
- 1,194
PainDr said:
In ASC with medicare approved procedures you get 100% ($333) for 1st level
and 50% ($166) for each subsequent level, so the total for the case mentioned above would 333+166+166+166+166=$999 for facility fee
-though I would reccomend narrowing down your pain generator ( 5 level RF
is little excessive)
