As promised this is an in-depth look into IOECTR, WALANT, and OBS. It was updated Sept 2, 2021
My goal with this guidebook is to provide information on how to set up and be fairly reimbursed for In-Office Endoscopic Carpal Tunnel Release (IOECTR). In other words, how to set up an Office-Based Surgical Suite (OBSS) and perform ECTR in your office rather than an ASC, HOPD, or hospital. Those facility locations would continue to be options, but if the patient is healthy enough most hand and wrist procedures can be performed safely, under local anesthesia, in the office suite.
This information is for Providers, insurance carriers, researchers, and professional associations. I recommend first downloading our latest OBS Reimbursement Checklist available under Posts on the website.
Don’t feel you have to read every chapter in this sixty-page guidebook. I recommend that you scan through the different topic headings for about twenty minutes before you read each chapter in detail. After extensive research (SEP 2021) into Office-Based ECTR reimbursement, I found a lot of information in regard to office-based surgery is generic, vague, or out-of-date. Very few address the issue of Site-of-Service Differential. I’ve read through dozens of articles and hundreds of pages of research and distilled it as best I could. There are numerous terms, acronyms, and definitions. A lot of the concepts (NON-FAC PE versus FAC PE) may be unfamiliar to you.
Remember that a carrier may deny ECTR when performed in the office or simply pay you the facility rate (FAC PE [essentially not reimbursing you any amount for the office-based surgical suite.])
There may be rare cases, where the insurance company, aware of the cost-benefits (to them), may add compensation to the reimbursement for the office surgical suite to encourage further use. From a negotiation standpoint it’s always best to start with the most expensive alternative–performing the procedures at the hospital–and show the insurance company how much they will save if they reimburse you for the overhead (“facility fee”) of your office-based surgical suite. Your historical facility usage will impact your ultimate strategy.
The book is set up in two sections: Section One for reimbursement negotiation and Section Two for those new to OBS with information on how to set up your OBS. There is also an Appendix with additional information for the truly curious.
All of my information will be available on the website: www.ioectr.com and in MS-Word (.doc) and MS Excel (.xls) format so you can search, cut-and-paste, and share it. The goal is to provide information that you can customize to your unique situation; cut-and-paste whatever you need into your negotiation document.
It is all free to share. It is royalty-free.
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