July has been a busy month for CMS, from facing Congressional pressure on a prior authorization overhaul to the addition of dental surgical codes in its prospective payment system proposal for 2024. Here is how four changes floated in the last 30 days will impact ASCs:
1. A bipartisan Congressional majority has put pressure on CMS to finalize a federal regulation that would overhaul prior authorization within Medicare Advantage. Congress is pushing CMS to add real-time electronic prior authorization decisions, allowing for faster approvals for ASCs.
2. CMS plans to add 26 dental surgical codes to the ASC payable list for next year. ASCA pitched 62 other surgical codes routinely performed in ASCs for non-Medicare patients, including total shoulder replacements, but CMS declined to add them.
3. CMS is floating a 3.34 percent conversion factor decrease in its proposed Medicare physician fee schedule for 2024. The proposed physician fee schedule conversion factor for 2024 is $32.75, down 3.34 percent from $33.89 in 2023.
4. CMS pitched a 2.8 percent average rate increase for ASCs next year in the 2024 hospital outpatient prospective payment system. It would also change the quality reporting program and extend the five-year interim period of using the same pay update factor for ASCs and HOPDs by two years.