Under ASC-PPS, what percentage of the national median charge is the patient responsible for paying as coinsurance?

Under the Ambulatory Surgical Center Prospective Payment System (ASC-PPS), the patient is responsible for paying 20% of the national median charge as coinsurance. This percentage is established as part of the cost-sharing model in the Medicare program, which seeks to balance coverage and patient responsibility.

The 20% coinsurance rate applies to the payment that Medicare makes to ambulatory surgical centers for covered services, ensuring that patients also have some financial responsibility for their care. This model aims to promote responsible healthcare spending while still providing significant financial support from Medicare.

Other percentages, such as 50%, 15%, and 80%, do not reflect the established coinsurance for ASC-PPS services under Medicare, making 20% the correct and relevant figure in this context. Understanding the coinsurance structure is vital for healthcare professionals involved in billing and reimbursement, as it directly influences patient financial responsibility and facility revenue management.