1. Negotiations with payors can be more difficult for spine than orthopedics. Since Medicare does not reimburse spine cases in the outpatient setting, negotiating ASC rates for spine cases with private payors can be more difficult than other specialties because payors often set rates at a percent or multiple of Medicare rates.

1. New CMS ASC payment system has generally increased orthopedic reimbursements. The transition to the new CMS ASC payment system, which pays centers at a percentage of HOPD rates, has increased the reimbursement rates of most orthopedic procedures, says Jay Rom, president of Blue Chip Surgical Center Partners. The system, which went into effect Jan. 1, 2008, and was designed to be phased in over a four-year period, continues to benefit orthopedic service lines as the percent of the payment formula determined by the new system is phased into the overall ASC reimbursement rate.

Published in News and Analysis