• E-mail
• Print
• RSS

CMS proposes major overhaul of ASC payment system in 2008

Ambulatory Surgery Reimbursement Update, August 15, 2006

The Centers for Medicare & Medicaid Services (CMS) last Tuesday issued its proposed rule outlining a new ambulatory surgery center (ASC) payment system and three other proposed changes to ASC payment policy. The new payment system would take effect January 1, 2008, while certain reimbursement cuts and revisions to the ASC list of Medicare-approved procedures will take effect January 1, 2007.

The proposed changes were issued as part of CMS' proposed rule for the 2007 outpatient prospective payment system (OPPS).

CMS proposes to base the new ASC payment system on corresponding payment rates in hospital outpatient departments (HOPDs). ASCs would receive 62% of the OPPS payment rates for HOPDs, which would reflect the lower costs associated with performing procedures in an ASC setting, according to a CMS press release.

"We believe that CMS has taken the right approach in looking at the HOPD system as the basis, but are dismayed that they are looking at a rate of 62%," says Kathy Bryant, president of FASA. "I don't understand how someone would think that we could provide care at a 38% discount."

Craig Jeffries, executive director of the American Association of Ambulatory Surgery Centers (AAASC), shared Bryant's sentiments in a statement issued by the AAASC.

"The AAASC is concerned that the inadequate reimbursement proposed by CMS will force procedures into the hospital setting, reducing beneficiary choice and increasing Medicare spending," Jeffries said.

As part of this change, ASCs would no longer use the nine payment groups rates currently assigned to ASC Medicare-approved procedures, but would switch to the 221 ambulatory payment classifications (APCs) used by HOPDs.

The list of procedures for which Medicare will reimburse ASCs would also change significantly in 2008 under the proposed rule. The current list includes about 2,500 Medicare-approved procedures. The proposed list would swell to 3,308 procedures effective January 1, 2008, according to FASA. The new list would include all procedures except those that pose a significant safety risk when performed in an ASC or that do not meet several requirements (e.g., Medicare would still not reimburse ASCs for procedures that require an overnight stay, as under the current rules).

The OPPS proposed rule also outlines ASC payment cuts that would take effect January 1, 2007. Under the Deficit Reduction Act of 2005, the Medicare payment rates for ASC services that currently carry a higher reimbursement rate when performed in an ASC than in an HOPD will drop to the corresponding HOPD rate. The proposed changes to the OPPS rates would reduce the rates for 274 procedures performed in ASCs in 2007.

To view the proposed rule, click here.

For more information from FASA on the proposed rule, click here.

To comment on the proposed rule, click here, then click on the link "Submit electronic comments on CMS regulations with an open comment period."

• E-mail to a Colleague
• Print
• RSS
• Archive