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Different Pay Rates by Michael Gorback MD


I’ve been trying to find the rationale for paying different rates for different points of service and I found a handy PDF file from HHS. These are just the first two paragraphs. According to Google translate (Bureaucrat to English) this says, “Rates are paid according to lobbying power. ASCs are less powerful than hospitals so they get paid less. Physician offices are paid the same as ASCs but in Zimbabwe dollars”.

“In the annual updates to the ASC payment system, CMS sets relative payment weights equal to OPPS relative payment weights for the same services and then scales the ASC weights to maintain budget neutrality from year to year, as mandated by the MMA. For calendar year (CY) 2013, the ASC relative payment weights were scaled to eliminate any difference in the total payment weight between CY 2012 and CY 2013.

The relative payment weights for CY 2013 were scaled by holding ASC utilization and mix of services constant from CY 2011 (the most recent full year of claims data available) and comparing the total payment weight using the CY 2012 ASC relative payment weights to the total payment weight using the applicable CY 2013 OPPS relative payment weights for covered ASC surgical procedures and separately payable ancillary services. This process takes into account the changes in the relative payment weights between CY 2012 and CY 2013.”

Send me 500 bitcoins by Wednesday or I will forward you the entire section and make your eyes bleed. And then I will send it to your loved ones. If you contact the FBI you will receive TWO copies.