Redefining Reimbursement for
Office-Based Surgery
Cataract surgery is the #1 outpatient procedure in healthcare, with nearly 4,000,000 cases performed annually in the U.S.
With an aging population, volume is expected to increase three percent per year reaching six million procedures by 2030. Most cataract surgeries are performed in multi-specialty ASCs, which de-prioritize cataract surgery in favor of more lucrative surgeries. As a result, ophthalmic surgeons have limited access to an OR, a backlog of cases and a long-term capacity problem. iOR Partners offers a way forward with office-based surgery (OBS).
It’s becoming more widely accepted that OBS is the future of ophthalmology. It’s an unprecedented move to physician-led healthcare that’s safe, convenient, and efficient. And that makes it good for your patients and your practice.
The evolution of OBS is closely mirroring the transition from hospital-based surgery to ASC-based surgery.
At iOR, we are redefining the surgery suite and redefining how we traditionally think about reimbursement.
We understand the regulatory and billing requirements for reimbursement. We review every claim and work with local MACs to help you receive the reimbursement you deserve.
By redirecting the payment formerly going to the surgical facility, we assist you in successfully putting money back into your practice.
Does Medicare Reimburse for Office-Based Surgery?
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 in all 12 local jurisdictions.
Will I receive a professional and facility fee?
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 reimbursement of the professional fee.
Is OBS reimbursement comparable to ASCs?
The money received for OBS is similar to what you receive in an ASC, they are just reimbursed in different ways. With OBS, you retain 100% of the surgical fee.
Surgeon Reimbursement Comparison
| ASC | OBS | |
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Surgeon Professional Fee Standard fee paid to surgeon for services. |
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Traditional Primary-National Fee Facility fee paid to ASC for overhead expenses. |
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Secondary-Local Fee Professional fee paid to surgeon for overhead expenses. |
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| Surgical Fees Retained by Surgeon |
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Is OBS Reimbursement Compliant?
iOR has a well-established, compliant model using local payors on more than 40,000 Medicare paid claims. We understand the regulatory and billing requirements to get you reimbursed. What’s more, we review every case, perform insurance pre-authorization, and submit OBS claims to facilitate reimbursement.
iOR office-based surgical suites are currently in 31 states and counting, with over
It’s Time You Said “Yes” to OBS
Now’s the chance to be part of this exciting shift in ophthalmic surgery. There’s a new standard of care for the #1 outpatient procedure in healthcare, and iOR is paving the way.
The evolution of OBS closely mirrors the transition from hospital-based surgery to ASC-based surgery. Like the previous transition, CMS will eventually streamline national OBS reimbursements.
iOR is engaged in productive conversations with the AAO and CMS regarding the valuation of cataract and glaucoma codes for 2025. Getting involved now provides the opportunity to be part of the process and have your voice heard.
Office-based surgery is the future. Will you lead or follow?
Find out what secondary-local reimbursements are in your area with a free analysis.