Joan Dentler, ASC Strategies: In order to bill Medicare with the hospital provider number (and collect HOPD reimbursement) the hospital must own 100 percent and the facility must be licensed and accredited by CMS as a hospital.
A CMS-certified ASC must bill Medicare freestanding ASC rates regardless of the hospital’s level of ownership. If a hospital has substantial ownership (usually 51 percent or greater) in a freestanding ASC, some private payors may be willing to negotiate higher rates than they would without the hospital having that level of ownership — sometimes very close to HOPD rates.
Every situation is different and needs to be looked at individually.
Contact Joan Dentler at jdentler@ascstrategies.com. Learn more about ASC Strategies at www.ascstrategies.com.
