How are bills for New Jersey-based ASCs (Ambulatory Surgical Centers) and hospitals reimbursed as per the EAPG payment methodology?
In situations where New Jersey-based ASCs or hospitals must bill in accordance with the EAPG payment methodology (e.g. the injured patient was a New York resident), reimbursement is calculated in similar fashion to New York-based ASCs and hospitals.
Rates of payment for out-of-state providers in counties contiguous to New York City and New York’s Dutchess, Putnam, Westchester, Rockland and Orange counties will reflect the average APG payment for the same services applicable to New York State providers in those downstate areas.
Out-of-state counties contiguous to the downstate rate region include Sussex, Passaic, Bergin, Hudson, Essex, Middlesex, Union and Monmouth Counties in New Jersey; Pike County in Pennsylvania; and Litchfield and Fairfield Counties in Connecticut.
Rates of payment for all other out-of-state providers will reflect the average APG payment for the same services applicable to providers in upstate New York.