State court denies Surgical Care Affiliates' fee schedule challenge: 5 facts

On April 6, the North Carolina Supreme Court denied Deerfield, Ill.-based Surgical Care Affiliates' request for a review of ASC provisions in the worker's compensation fee schedule.

Here's what you should know:

1. On Nov. 21, 2017, the Court of Appeals unanimously ruled the ASC provisions of the workers' compensation medical fee schedule that became effective April 1, 2015, were valid. The decision can be read here.

2. The court's decision reversed Superior Court Judge Paul Ridgeway's 2016 decision, affirming the Industrial Commission's 2015 ruling.

3. Following the decision, Surgical Care Affiliates requested a Petition for Discretionary Review. The request was denied, leaving the November 2017 Court of Appeals decision in place.

4. Rule 11 NCAC 23J .0103, which went into effect April 1, 2015, will remain in effect for ASCs.

5. The rule states, "A maximum reimbursement rate of 200 percent shall apply to institutional services that are eligible for payment by CMS when performed at an ASC."

In addition, "A maximum reimbursement rate of 135 percent shall apply to institutional services performed at an ASC that are eligible for payment by CMS if performed at an outpatient hospital facility, but would not be eligible for payment by CMS if performed at an ASC."

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