FAQs

Office-based surgery is any surgical or invasive procedure performed by a licensed physician in a location other than a hospital or ambulatory surgery center. These procedures are typically performed in a suite located within the physician's office. 

Yes, over 68,000 cases have been safely performed in the OBS setting: 

• In 2016, Kaiser Permanente published a study on 21,501 cataract cases performed in the office setting, with outcomes that were consistent with hospitals or ASCs 
• A 2023 Journal of Cataract & Refractive Surgery multicenter study on 18,005 office-based lens surgery demonstrated that the safety of office-based lens surgery either matches or exceeds the literature-reported values of adverse events documented for modern cataract surgery. Lead author, Lance Kugler, MD, shared his findings as ASCRS 2023. 
• iOR Partners has been gathering data, with data from 47,000 real-world cases that also match or beat safety outcomes in other settings. 
  

Download Safety Paper

 

Common ophthalmic OBS procedures include cataract surgery, retina procedures, glaucoma procedures, refractive lens exchange, ICL, various oculoplastics and other lens-based procedures.

Other specialties that commonly perform procedures in an OBS include gastroenterology, otolaryngology, dermatology, cardiology, and maxillofacial surgery.

99% of cases performed in iOR suites are done with oral and topical sedation only, typically with 5-10mg of Valium. If you need or prefer IV anesthesia, we can accommodate that level of sedation. However, most of our surgeon partners have determined that oral or sublingual sedation is adequate, patient-preferred, and a safer way to perform cataract surgery.

Learn more about anesthesia for OBS here

Yes, all 50 states allow for OBS. The rules for OBS suites don’t vary much by state and we are familiar with the rules and regulations in all 50 states. We have implemented iOR suites in over 35 states.

Typically, CON laws have no effect on office-based surgery. The CON rules apply to an ASC and since OBS is an extension of your practice you’re already able to perform surgery in your office. If you’re performing LASIK than you are performing surgery in your practice.

Usually, it does not have an impact, but you will need to confirm with your malpractice carrier.

Yes, iOR has been successful in collecting reimbursements from all major payers, including Medicare. Learn More

iOR Reimbursement Mix:

 

Those with financial interests in ASCs have touted that Medicare has "rejected payment for ophthalmic office-based surgery".  However, this statement is misleading.   

You can receive Medicare reimbursement for OBS. You’re simply paid in a different way. Instead of a Traditional Primary-National reimbursement of the facility fee, OBS surgeons receive a Secondary-Local reimbursement of their professional fee based on local Medicare Administrative Contractor (MAC) codes. Learn More

 

You’re always paid a standard professional fee regardless of where you perform surgery. Instead of a facility fee, you will receive a Secondary-Local professional fee reimbursement.

Office-based surgery billing is more complex than billing in an ASC or hospital and requires highly specialized expertise.  iOR has a well-established, compliant model using local payors on more than 209,000 paid claims. We review every case, perform insurance pre-authorization, and submit OBS claims to facilitate reimbursement.  Multiple audits have been performed on our claims with no deficiencies.

The money received for OBS is similar to that for ASC, but they are reimbursed differently. OBS payments can be slightly higher on average because they are not standardized yet. In addition, with OBS, there is lower overhead and a faster breakeven point. 

iOR Partners understands the regulatory and billing requirements needed for office-based surgery reimbursement. We review every case our surgeon partners submit a claim on, perform insurance preauthorization and choose the right mechanism for billing that will facilitate appropriate reimbursement for non-professional costs associated with the procedures.   

• iOR Revenue Cycle Management (RCM) Services include: 

• Dedicated iOR RCM Team 

• OBS Payor Credentialing 

• Verification of Benefits 

• Prior Authorization of OBS 

• Single Case Agreements 

• One Time Authorization 

• Gap exception 

• Recommend billing method 

• OBS claim submission and billing staff support 

• Appeal claims and negotiate payments   

• OBS Payor Contracting 
   

An OBS takes a fraction of the time, space, and cost of building an ASC. Implementing an iOR Suite is financially feasible with as few as 30 cases a month.

Space requirements and costs may vary depending on your equipment choices among other variables.   
 
An iOR Suite can be built with as little as 700 square feet (sq. ft.) for one OR or 1000 sq. ft. for two ORs.  Instrument processing, sterile supply, and pre/post take approximately 200 sq. ft. 
 
Buildout costs are nearly identical to building out clinic space.  We will work closely with your architect and contractor to negotiate rates and ensure the space will meet accreditation standards.

From space planning and development to onboarding and staff training, we need at least 90-120 days from signing of your agreement to first day of surgery.

Yes. This is a major advantage of working with iOR. We have national account status with all the major ophthalmic vendors and a GPO for ongoing savings on supplies for your practice.

Almost every OBS suite utilizes the current clinic staff as the Ophthalmic Procedure Tech, Circulator, Sterilizer, and Pre/Post Op.  iOR Partners trains all surgical staff to current standard competencies.

Yes, either by The Joint Commission or Quad A accreditation. Learn more about anesthesia for OBS here.