Does anyone have any experience with contract negotiations for surgical procedures, which are typically performed in a facility (SOSD=0), and are now performed in an OBSS (Office-Based Surgical Suite)? The POS is now 11.
This is growing in popularity in orthopedics (hand and wrist), podiatry (foot procedures), and ophthalmology (cataract surgery).
While still somewhat rare, with the advent of WALANT and improvements in local anesthesia, a lot of surgeons are looking for ways to provide a superior service to their patients that is both safe and convenient by establishing an OBSS.
Note that this issue covers 90-day surgical procedures where the “Non-Facility NA INDICATOR” flag in the PFSRVU database has a status indicator of "NA". The procedures are easy to identify as the NON-FAC PE = FAC PE (therefore zero). It is not an issue where the surgeon is compensated for the OBSS or with simple 10-day procedures commonly performed in the office. They will have a SOSD. Interestingly enough, the amount can range from a few dollars to thousands.
When the Site-of-Service Differential (SOSD) equals zero there is no additional reimbursement for the office surgical suite overhead. Since you are saving both the insurance company and the patient the expense of a separate facility bill, the strategy is to negotiate a carve-out for the office overhead. This has to be done with each carrier, individually.
I’ve spent considerable time gathering information on this but would love to communicate with other managers, billers, and coders that have actually worked the process. There is so little information on this topic!
Thanks
- Jeff
This is growing in popularity in orthopedics (hand and wrist), podiatry (foot procedures), and ophthalmology (cataract surgery).
While still somewhat rare, with the advent of WALANT and improvements in local anesthesia, a lot of surgeons are looking for ways to provide a superior service to their patients that is both safe and convenient by establishing an OBSS.
Note that this issue covers 90-day surgical procedures where the “Non-Facility NA INDICATOR” flag in the PFSRVU database has a status indicator of "NA". The procedures are easy to identify as the NON-FAC PE = FAC PE (therefore zero). It is not an issue where the surgeon is compensated for the OBSS or with simple 10-day procedures commonly performed in the office. They will have a SOSD. Interestingly enough, the amount can range from a few dollars to thousands.
When the Site-of-Service Differential (SOSD) equals zero there is no additional reimbursement for the office surgical suite overhead. Since you are saving both the insurance company and the patient the expense of a separate facility bill, the strategy is to negotiate a carve-out for the office overhead. This has to be done with each carrier, individually.
I’ve spent considerable time gathering information on this but would love to communicate with other managers, billers, and coders that have actually worked the process. There is so little information on this topic!
Thanks
- Jeff