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Outpatient ASC Detailed Explanation Explained
A Detailed Explanation is provided for each Procedure Code entered. The Detailed Explanation provides information about the calculation factors DaisyBill uses to determine OMFS reimbursement.
Let’s break down a Detailed Explanation.
A. Fee Schedule
The Procedure Code falls under this Fee Schedule.
A short Description of the Procedure Code.
C. Effective Dates of Service
The Effective Dates of Service provides the Dates of Service the calculated OMFS reimbursement amount is effective. The Outpatient ASC Calculator calculates accurate reimbursement for dates of service 12/15/16 to present.
F. Base Calculation Explanation
Provides the Relative Weight (applicable on Date of Service), Conversion Factor and Multiplier for each Procedure Code.
The Total is the maximum reimbursement per the OMFS for the Procedure Code on the given Date of Service. The Total does not include calculations for Billing Ground Rules (eg., surgical cascading, status codes, etc). The Total may differ from the OMFS reimbursement calculated which does account for Billing Ground Rules.
For detailed information regarding the calculation of Total see §9789.33. Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule - Determination of Maximum Reasonable Fee.
H. Billing Ground Rules
Billing Ground Rules are fee affecting regulations that determine the calculated OMFS reimbursement. Billing Ground Rules are applied to the Base Maximum Fee calculation to produce the OMFS reimbursement.
For detailed information regarding applicable Billing Ground Rules see §9789.33. Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule - Determination of Maximum Reasonable Fee.
I. Addendum B - OPPS Payment HCPCS Code
Addendum B - OPPS Payment HCPCS Code provides values from CMS Addendum B including the CMS filename in which they can be found.
J. Addendum D1 - OPPS Payment Status Indicator
Addendum D1 - OPPS Payment Status Indicator provides values from CMS Addendum
D1 including the CMS filename in which they can be found.
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