CMS' policies have the power to turn the tide of the surgery center industry. Here is how those policies have both helped and hurt ASCs in 2023.
Helped
- CMS updated ASC payment rates to 3.8 percent in its 2023 "Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule."
- In December, CMS submitted a 134-page proposal designed to improve prior authorizations for Medicare and Medicaid patients through automating the process and improving workflows. The proposal requires certain payers to address the administrative hassles of prior authorization by requiring the implementation of an automated process, meeting shorter time frames for decision-making and improving transparency.
- In its 2023 final rule, CMS implemented a policy that provides complexity adjustments for certain ASC procedures. According to VMG Health's 2023 mergers and acquisitions report, these adjustments are applied to "combinations of primary procedures and add-on codes deemed eligible under the hospital [outpatient prospective payment system]." Previously, add-on codes did not receive more reimbursement when bundled with primary codes. This policy allows Medicare to provide adjustments to the payment rate to account for the costs of specific services.
Hurt
- The conversion factor used to calculate physician reimbursement declined by $1.55 to $33.06 in 2023, representing a 4.48 percent decrease.
- In November, CMS released the Medicare payment and policy change final rule. The rule kept a 2 percent Medicare reimbursement cut to physicians in 2023, and 2024 may bring at least another 1.25 percent cut.
- In its 2023 final rule, CMS considered 64 recommendations for new procedures to be added to the ASC-covered procedures list, but only four procedures that are typically performed in an outpatient setting were chosen.