Medicare reimbursement for ASC is roughly what percent of what they reimburse HOPDs?

Medicare reimbursement for ASC is roughly what percent of what they reimburse HOPDs?

• A. 53% to 67%
• B. 25% to 40%
• C. 70% to 90%
• D. 100%

Answer: (A)

Medicare pays ambulatory surgical centers at a fraction of what it pays hospital outpatient departments. The typical range is about 53% to 67% of the HOPD reimbursement. This reflects the separate ASC payment system, which covers facility costs differently and generally has lower overhead than a hospital outpatient department. For example, if a procedure is reimbursed $1,000 in an HOPD, the ASC would usually receive around $530 to $670. The other options—25%–40% (too low), 70%–90% (higher than typical HOPD rates), and 100% (no difference)—do not align with how Medicare separates and scales ASC payments relative to HOPDs.

Medicare pays ambulatory surgical centers at a fraction of what it pays hospital outpatient departments. The typical range is about 53% to 67% of the HOPD reimbursement. This reflects the separate ASC payment system, which covers facility costs differently and generally has lower overhead than a hospital outpatient department.

For example, if a procedure is reimbursed $1,000 in an HOPD, the ASC would usually receive around $530 to $670. The other options—25%–40% (too low), 70%–90% (higher than typical HOPD rates), and 100% (no difference)—do not align with how Medicare separates and scales ASC payments relative to HOPDs.