Wiki Does the Medicare Multiple Procedures Rule Apply to facilities?

[stacyciccone]

Hoping to get some clarification - Does the Medicare Multiple Procedures Rule apply to facilities (billing for the facility - Ambulatory Surgical Centers, Outpatient Hospital Surgeries) or is it just for the Providers? Hoping to get specific answer to this. Thank you!

 

[thomas7331]

Facilities are also subject to multiple procedure reductions, although the rules are quite a bit different from those for providers. Providers are paid under the Medicare Physician Fee Schedule whereas facilities are paid under the Outpatient Prospective Payment System, so the way that payment rates are determined is very different. Some facility procedures are paid at a fee schedule rate which may involve a multiple procedure reduction, but many services are paid at a comprehensive APC which is a single flat fee case rate that covers all services performed at the encounter.

 

[stacyciccone]

Facilities are also subject to multiple procedure reductions, although the rules are quite a bit different from those for providers. Providers are paid under the Medicare Physician Fee Schedule whereas facilities are paid under the Outpatient Prospective Payment System, so the way that payment rates are determined is very different. Some facility procedures are paid at a fee schedule rate which may involve a multiple procedure reduction, but many services are paid at a comprehensive APC which is a single flat fee case rate that covers all services performed at the encounter.

Thank you!