Rule 4123-6-37.3 | Payment of ambulatory surgical center services.
Unless an MCO has negotiated a different payment rate with an ambulatory surgical center pursuant to rule 4123-6-10 of the Administrative Code, reimbursement for ambulatory surgical center services with a date of service of May 1, 2023 or after will be equal to the lesser of the ambulatory surgical center's allowable billed charges or the fee schedule amount indicated in the appendix to this rule, developed with provider and employer input and effective May 1, 2023.
Ambulatory surgical centers determined as of the effective date of this rule by the centers for medicare and medicaid services (CMS) to not meet quality measures for the calendar year 2023 full payment update under the CMS ambulatory surgical center quality reporting (ASCQR) program, established by 42 U.S.C. 1395l as in effect as of the effective date of this rule and 42 C.F.R. Part 416, Subpart H as published in the October 3, 2022 Code of Federal Regulations, will be subject to a two per cent reduction to the BWC 2023 ambulatory surgical center fee schedule amounts indicated in the appendix to this rule.
However, if such an ambulatory surgical center, upon reconsideration, is subsequently determined by CMS to meet quality measures for the calendar year 2023 full payment update under the CMS ASCQR program, upon the ambulatory surgical center's request the ambulatory surgical center will no longer be subject to the two per cent reduction, and the bureau will adjust any bills for dates of service on or after the effective date of this rule that were previously reduced pursuant to this rule.
Last updated March 29, 2024 at 1:32 PM
Supplemental Information
Amplifies: 4121.12, 4121.121, 4121.44, 4121.441, 4123.66
Five Year Review Date: 5/1/2025
Prior Effective Dates: 4/1/2009, 4/1/2010, 4/1/2011, 4/1/2012, 4/1/2013, 5/5/2014, 5/1/2015, 5/1/2016, 5/1/2017, 5/1/2018, 5/1/2019, 5/16/2020, 5/6/2021, 5/1/2022