Do You Know the Rule? Payment of Ambulatory Surgical Center Services in Ohio

Columbus, OH (WorkersCompensation.com) -- Some new rules have kicked in in the Buckeye State regarding ambulatory surgical center services. With May upon us, here's a look at what those new rules are.

Unless a managed care organization has negotiated a different payment rate with an ambulatory surgical, reimbursement for ambulatory surgical center services with a date of service of May 1, 2024, or after will be equal to the lesser of the ambulatory surgical center's allowable billed charges or the fee schedule amount indicated in an appendix to Rule 4123-6-37.3, developed with provider and employer input and effective May 1, 2024.

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Ambulatory surgical centers determined as of the effective date of this rule by the Centers for Medicare and Medicaid services to not meet quality measures for the calendar year 2024 full payment update under the CMS ambulatory surgical center quality reporting program will be subject to a 2% reduction to the BWC 2024 ambulatory surgical center fee schedule amounts indicated in the appendix.

However, if an ambulatory surgical center, upon reconsideration, is subsequently determined by CMS to meet quality measures for the calendar year 2024 full payment update under the CMS ASCQR program, upon the ambulatory surgical center's request the ambulatory surgical center will no longer be subject to the 2% reduction, and the bureau will adjust any bills for dates of service on or after the effective date of this rule that were previously reduced pursuant to this rule.

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