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ASCs in the news: CMS releases 2009 ASC proposed rule: ASC payments still changing

Ambulatory Surgery Reimbursement Update, July 8, 2008

CMS released its Outpatient Prospective Payment System (OPPS) and ASC proposed rule for fiscal year (FY) 2009 on July 3, some two weeks earlier than usual. In addition to its proposed coding, billing, and payment changes for hospital outpatient services, the proposed rule also includes the 2009 proposed changes for ASCs. The ASC proposed rule continues the move to the new ASC payment rates, with ASC services paid at a 50/50 blend of the 2007 ASC payment and the 2009 ASC payment (i.e., 65% of the hospital outpatient rate). The update to ASC rates is the second year of a four-year transition to align these rates with those paid to hospital outpatient departments and minimize the impact of financial incentives on decisions about treatment settings.

How beneficial are the changes for ASCs? “On a preliminary basis, the proposed rule could offer some partial offset to rising ASC expenses,” says Justine B. Corday, Chief Development Officer at Physicians Health Resources in Chicago. “However, it’s unclear whether it would allow the lowest rate procedure reimbursements any benefit.”

The statutory copayment (under Medicare law, not to exceed 40% of the total payment for the APC) is also still in transition. CMS is gradually replacing it with 20% coinsurance as payment rates for the APCs increase. CMS expects that the beneficiary share of the proposed total payments for Medicare covered outpatient services will be about 23% in CY 2009.

Editor’s note: The 2009 OPPS proposed rule is scheduled to be published in the July 18 Federal Register. Comments on the proposed rule will be accepted through September 2. CMS will respond to comments in a final rule that it expects to release on or before November 1. Should the changes become final, they will become effective as of January 1, 2009.

To view the OPPS/ASC proposed rule for 2009, click here.

Look for more in-depth coverage of these and other proposed changes in upcoming issues of Ambulatory Surgery Compliance and Reimbursement Insider.

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