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ASC Medicare Payment Modernization Act introduced

Ambulatory Surgery Reimbursement Update, April 3, 2007

A new ambulatory surgery center (ASC) payment system proposal was introduced by House representatives Wally Herger (R-CA) and Kendrick Meek (D-FL) March 29, according to FASA and the American Association of Ambulatory Surgery Centers (AAASC).

In conjunction with this anticipated system, the ASC community, working together with the House, suggested a reform to the way the Centers for Medicare & Medicaid Services (CMS) determine what procedures ASCs are reimbursed for by Medicare.

If the Ambulatory Surgical Center Payment Modernization Act of 2007 (HR 1823) is passed, CMS would reimburse ASCs a flat 75% of the hospital outpatient department (HOPD) rate.

The legislation also proposed to require CMS to develop a list of procedures ASCs would not be paid for by Medicare; ASCs currently use a Medicare-approved procedure list.

The bill would also apply the inflation factor used to update HOPD rates to ASC payments.

The model for this bill came from the Medicare Payment Advisory Commission's suggestion that ASCs should be allowed to perform and receive Medicare facility payments for most surgical services, except for procedures that the Health and Human Services Secretary deems a specific risk in an ASC setting or procedures where an overnight stay is necessary.

To view information from FASA on the legislation, click here.

For more information from the AAASC, including a link to the bill, click here.

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