• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • WCW HOME
  • Submit a Wire!
  • Advertising
  • Media Partners
  • About
  • Contact Us

WorkCompWire

Your Trusted Source for Workers Compensation News

Enlyte
  • Workers Compensation News
    • Workers Compensation Industry News
    • Association, Rating & Research News
    • Claims, Legal, & Compliance News
    • Legislative & Regulatory News
    • Risk Management News
    • Work Force & Human Resource News
  • Featured Articles
  • Leaders Speak
  • Editor’s Forum
  • People On The Move

WCRI FlashReport Examines Role of Recent Fee Schedule Changes on ASC Payments in GA

April 8, 2021 - WorkCompWire

Cambridge, MA – A new FlashReport from the Workers Compensation Research Institute (WCRI) examines recent trends in payments to ambulatory surgery centers (ASCs) in Georgia and the role of recent fee schedule changes, including changes to Medicare Hospital Outpatient Prospective Payment System (OPPS) reimbursement rates, which are the basis of the Georgia workers’ compensation outpatient fee schedule.

“While focused on a single state, this analysis has application beyond Georgia, as several states tie reimbursement for facility services conducted in the ASC setting to Medicare rates. Therefore, this is a helpful case study of one state’s experience incorporating Medicare changes into its workers’ compensation fee schedule for ASC facility services,” said Ramona Tanabe, executive vice president and counsel of WCRI.

The study, ­­­­­­­­­­­­­­­­­­­­­­­­­­Payments to Ambulatory Surgery Centers in Georgia: Role of Recent Fee Schedule Changes, focuses on the trends in ASC facility payments per episode for common knee and shoulder arthroscopies. The report found that the trends in facility payments varied across procedures. For example, two of the three common knee surgeries examined have experienced small increases in ASC facility payments per episode since 2014. The third knee surgery has experienced a large decrease since 2014, which followed a rapid increase from 2013 to 2014.

The recent trends in ASC facility payments for these surgeries may reflect several fee schedule changes, including the introduction of comprehensive ambulatory payment classifications and the restructuring of ambulatory payment classifications by the U.S. Centers for Medicare & Medicaid Services, which were largely incorporated by the Georgia workers’ compensation fee schedule. Additionally, Georgia introduced different reimbursement rates for ASCs from those for hospital outpatient departments in 2018, with the ASC rates set at 210 percent of the final OPPS payment rate. Previously, fee schedule rates for both ASCs and hospital outpatient providers were set at 225 percent of OPPS rates. In addition, other factors unrelated to the fee schedule may have also contributed to the recent trends in ASC payments in Georgia.

William Monnin-Browder, Rebecca Yang, and Bogdan Savych are the authors of the study.

Learn more or download a copy: WCRI: Payments to Ambulatory Surgery Centers in Georgia: Role of Recent Fee Schedule Changes

Source: WCRI

Filed Under: Association, Rating & Research News, Industry News, Legislative & Regulatory News, Top Stories, Workers' Compensation

Primary Sidebar

Get Our Free Newsletter:

Select list(s) to subscribe to


By submitting this form, you are consenting to receive marketing emails from: WorkCompWire.com, PO Box 1114, Culver City, CA, 90232, http://www.workcompwire.com. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact

myMatrixx

Paradigm

MSQ

Follow Us on Twitter

Tweets by WorkCompWire

Workers Compensation News Topics

  • Top Stories
  • Featured Articles
  • Leaders Speak
  • Editor’s Forum
  • The RxProfessor
  • Industry News
  • Association, Rating & Research News
  • People On The Move
  • Claims, Legal, & Compliance News
  • Legislative & Regulatory News
  • Risk Management News
  • Work Force & Human Resource News
  • Workers’ Compensation

Wire Archives

Copyright WorkCompWire © 2023