April 19, 2018

CASA Comments on CA DWC Update to Ambulatory Surgery Center Fee Schedule

Yesterday afternoon, the California Division of Workers’ Compensation (DWC) posted adjustments to the outpatient hospital departments and ambulatory surgical centers section of the official medical fee schedule (OMFS). The changes conform to the Medicare payment system as required by Labor Code section 5307.1. These changes will take effect September 15, 2011.

The ASC reimbursement remains at 122% of the Center for Medicare and Medicaid Services (CMS) Hospital Outpatient fee schedule, with the amendments to conform to the Hospital Outpatient Prospective Payment System (HOPPS) final rule of November 24, 2010. This is very good news for the ASC industry.

The DWC had originally proposed to reduce the ASC reimbursement to 122% of the CMS ASC fee schedule, which would have meant a drastic 40-60% reduction in reimbursement for the ASC industry. This change would have severely impacted the access to timely care for the injured California worker.

After written and verbal testimony from CASA and ASC leaders, the DWC in January altered their original proposal to 100% of the CMS HOPD fee schedule, approximately a 20% reduction from the current ASC reimbursement. Although better, the impact would still have significant ramifications and CASA continued to have dialogue with the Division regarding the potential consequences and the value of the ASC industry.

Through the efforts of many of you and the CASA leadership, the DWC has delayed implementing their proposed changes. It is very important that we remain diligent as the DWC has been very clear that they are seeking to find savings in the system and feel that the ASC community is part of that savings plan.

CASA will have the new 2011 Workers’ Compensation calculator posted to the CASA website in the coming days. The 2011 fee schedule will be for services rendered on September 15, 2011 and a

Further information and the adjustments to the outpatient hospital departments and ambulatory surgical centers section of the OMFS can be found on the DWC Web site.

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