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CMS revamps ASC payment system, Medicare-approved procedure list for 2008

Ambulatory Surgery Reimbursement Update, July 24, 2007

The Centers for Medicare & Medicaid Services (CMS) issued its final rule July 16 outlining a revised ambulatory surgery center (ASC) payment system and an expanded list of Medicare-approved procedures for ASCs.

CMS also issued a combined Outpatient Prospective Payment System (OPPS)/ASC proposed rule that would update the hospital OPPS effective for services provided during calendar year 2008 for Medicare beneficiaries, according to the CMS Web site.

The new ASC payment system is based on the OPPS, using OPPS relative payment weights for Ambulatory Payment Classifications (APC) as a guideline. ASCs will receive 65% of the OPPS rates under the proposed OPPS/ASC payment system or 67% of the corresponding payment rates for the APCs, higher than the originally proposed 62%, according to CMS' press release.

"We are pleased with CMS' final rule on ASC payment as it moves toward the policy objectives of the (American Association of Ambulatory Surgery Centers (AAASC))," says Craig Jeffries, executive director of the AAASC. "Unfortunately, CMS has fallen short on a number of key areas. The impact of 67% based on the proposed 62% or the 65% based on a recalibration and updated data for the 2008 implementation is still woefully below a rate necessary to sustain access for Medicare beneficiaries to the lower cost environment available in the ASC."

The final rule's payment rates will be published as part of the 2008 OPPS/ASC final rule later this year. The final rule will create a four-year transition period for implementing the revised rates so that ASCs have sufficient time to adjust to the new system.

For more information on the ASC final rule, click here.