What percentage of an ASC's revenue comes from Medicare?

• A. 17%
• B. 10%
• C. 5%
• D. 25%

Answer: (A)

Payer mix and how much of an ASC’s revenue comes from Medicare is the idea being tested. In ambulatory surgery centers, revenue comes from multiple payers, and while Medicare is a steady source, it usually represents a minority of total revenue. This is because many ASC cases are performed for privately insured patients or under managed care arrangements, where reimbursement levels are higher than Medicare’s. Medicare’s share tends to be in the high single digits to the low teens or, in many markets, around the high teens. So 17% fits as a representative figure for Medicare’s portion of ASC revenue, whereas 5% or 10% would underestimate it, and 25% would imply Medicare is the primary payer in most cases.