Wiki Insight needed on ASC Reimbursement

[chrish119]

Hello All,

I was hoping someone could give me some insight on how a CMS 1500 form with place of service 24 is reimbursed. Would it be reimbursed using the ASC formula with ASC payment rate or the Physician fee schedule and formula using Facility PE RVUs?

Thank you,
Chris H
Medical Claim Manager
chrish119@juno.com

 

[thomas7331]

If you're billing for the facility, and your payer requires or allows for the facility to bill on a 1500 form, then it should be reimbursed under the facility APC rate (or other methodology depending on the payer contract). If you're billing the physician claim, then the claim would be reimbursed under the physician's fee schedule at the facility rate. The provider information on the claim should drive it to the correct reimbursement rates based on the type of provider.