ASC Fee Schedule
Best Practices: Tip #3

In our two previous tips, we discussed auditing your fee schedule to determine if fees are in line with contract reimbursement allowances and how to decide when and how much to increase fees.

This week we are going to assist you in establishing what the least amount your ASC should charge for a procedure. We are all aware that private and government payers allocate very low payments for some procedures. In some cases, reimbursement is so low, a percentage above contact fees may not be sufficient.  Think about the overhead required to keep your ORs running: How much does it cost for a patient to walk through your door?

Follow this guidance to help determine an appropriate baseline fee.

Tip #3:  Minimum Baseline Fee

  • Review your lowest contract allowances and the lowest fee you are charging to determine your current baseline. It’s important to remember that Medicare regulations do not allow you to charge less for a procedure than the Medicare reimbursement rate for your area.
  • Think about the overhead required to keep your ORs running and then establish a minimum amount you’ll charge for such low-cost procedures as colonoscopies.

Your minimum fee should take the following costs into account:

  • Supply costs
  • Salary costs for all staff taking care of the patient’s needs (not just clinical and OR staff).
  • Direct costs, which are expenses that occur for every patient entering your facility (e.g., insurance verification, demographic input, preoperative testing, patient financial counseling, time spent in preoperative area/OR/recovery, postoperative patient education, postoperative phone calls).
  • Fixed indirect costs, which are expenses not directly related to the providing of care (e.g., utilities, maintenance, insurance, property taxes and depreciation). 

After taking into account all of the costs involved, our recommendation is a baseline fee of $1,000 to $1,500 as the least amount your facility should charge for any procedure.

Whatever minimum baseline fee you decide on, remember that to remain compliant, your ASC must charge the same fee for each specific procedure to all third-party payers, including state and federal programs such as Medicare and Medicaid.

Access Tip #1 on Auditing ASC Fees. Access Tip #2 on Fee Schedule Increases. Stay tuned for our Tip #4: Documenting Your Fee Schedule Changes.

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