To use the Outpatient ASC Calculator to calculate reimbursements for outpatient hospital and Ambulatory Surgical Center (ASC) facility reimbursement, follow these instructions.
Note: The Outpatient ASC Calculator is able to provide accurate reimbursement for dates of service from 12/15/2016 to present.
Step 1. Select ‘Outpatient ASC’
Step 2. Enter ‘DOS’
An accurate OMFS reimbursement amount requires the Date of Service. OMFS reimbursement amounts are calculated using the fee schedule(s) in effect on the date the services were rendered. The Outpatient ASC Calculator stores historical reimbursement data for dates of service 12/15/2016 to present.
Step 3. Select ‘Outpatient Hospital’ or ‘Ambulatory Surgical Center'
An accurate OMFS reimbursement amount requires accurate information on where services were performed.
Select Outpatient Hospital and provide Hospital Medical Provider Number to look up reimbursement for services rendered in an outpatient hospital.
Select Ambulatory Surgical Center and select County Name to look up reimbursement for for services rendered in an Ambulatory Surgical Center.
Step 4. Enter ‘Procedure Code’
HCPCS / CPT Codes that describe services rendered.
Step 5. Optional: Enter ‘Modifiers’
Enter applicable Modifiers for the Procedure Code. Some Modifiers affect reimbursement calculations (referred to as ‘fee-affecting’ modifiers) or may affect Correct Coding Initiative (CCI) edits.
Step 6. Enter ‘Units’
Enter the number of Units to represent the quantity of the Procedure Code.
Step 7. Optional: Enter ‘Payment Total’
Enter the reimbursement amount allowed by the claims administrator as reported on an explanation of review (EOR). This optional field defaults to $0. The Payment Total amount is used to calculate the Expected %.
Step 8. Optional: Repeat steps 4-7 for additional Procedure Codes
Step 9. Click ‘Calculate’
Click the Trashcan icon to delete a Procedure Code prior to calculation.
Step 10. View the calculations
For more information on calculations see the Help Articles: California Calculator Results Explained and Outpatient ASC Detailed Explanation Explained.
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