Why are there naysayers claiming that Medicare does not reimburse for OBS?
Office-based surgery billing is more complex than the ASC or hospital setting and requires highly specialized expertise.
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.
Is OBS billing Medicare compliant?
iOR Partners employs a robust and compliant billing method known as 'Code-Set Billing'. This method involves negotiating with local Medicare Administrative Contractors (MACs) using Local Coverage Determination (LCD). On a case-by-case basis, we seek permission from the local MACs to bill the primary code along with secondary codes, modified for use on cataracts and other ophthalmic surgical procedures in the office setting. If permission is not granted, we do not seek reimbursement for the claim. This process has been audited multiple times in several jurisdictions, with over 55,420 Medicare claims paid to date, and zero refunds or deficiencies.
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 professional fee reimbursement.
Can I get reimbursed for ophthalmic office-based surgery?
Yes, iOR has been successful in collecting reimbursements from all major payers, including Medicare.
iOR Reimbursement Mix:
How does the reimbursement amount compare to an ASC?
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.
Will CMS standardize OBS reimbursement?
Will OBS lower the professional reimbursement?
OBS saves Medicare dollars by eliminating an anesthesia provider and physician medical clearance. It does not impact the professional reimbursement.
Should I wait for CMS to establish primary-national Medicare reimbursement?
The evolution of OBS closely mirrors the transition from hospital-based surgery to ASC surgery. More and more surgeons are choosing to make the transition now because OBS is beneficial for their practices. Being at the forefront of evolution provides you with an excellent opportunity to contribute to the revaluation process.
