Here are six recent moves by CMS that may benefit — or burden — ASCs, as reported by Becker's in 2024:
Wins
1. Beginning this year, CMS added 11 procedures to the ASC-covered payment list, which included the addition of total shoulder and ankle joint reconstruction and meniscus transplants. The full list of newly payable procedures can be found here.
2. CMS updated its regulations for prior authorization for Medicare Advantage organizations, state Medicaid and Children's Health Insurance Program plans, Medicaid managed care plans, CHIP managed care entities and Qualified Health Plan issuers.
It will now require the implementation of healthcare data resources that will streamline the prior authorization process for ASCs and physicians. It also requires payers to add information about prior authorizations to their patient access API and to provide a reason for why a prior authorization request was denied. Payers must also make prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests by 2027. This should reduce the administrative burden on ASCs.
3. A Medicare payment rate increase of 3.1% for ASCs was finalized for 2024. The rate is based on the projected hospital market basket increase of 3.3%, reduced by 0.2% for the productivity adjustment.
4. CMS launched a program to accelerate payments to Medicare Part A providers and advance payments to Part B providers who were impacted by the Change Healthcare cyberattack, which was estimated to have had a $100 million daily impact on the healthcare industry.
Losses
1. Congress released a $460 billion spending package that would halve 2024's 3.4% Medicare pay cut for physicians to approximately 1.7% until Jan. 1, 2025, a move physicians say doesn't go far enough.
2. The Medicare Payment Advisory Commission recommended a roughly 3% year-over-year pay increase for physicians to Congress — however, some healthcare leaders have said that even with the proposed bump, pay is still "lagging." The report also recommended tying physician payments to the Medicare Economic Index.
"MedPAC's decision recognizes that physician pay is lagging far behind the cost of practicing medicine," American Medical Association President Jesse Ehrenfeld, MD, said in a March 15 statement. "Yet an update tied to 50% of MEI — as MedPAC recommended — will cause physician payment to fall even further behind increases in the cost of providing care."