Here are six CMS moves that are helping and hurting ASCs.
Helping
- CMS announced a program that will accelerate payments to Medicare Part A providers and advance payments to Part B providers who were impacted by the Change Healthcare cyberattack.
- Under CMS' Interoperability and Prior Authorization final rule, certain payers have to communicate if and why a prior authorization request is denied. Impacted payers must send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests beginning in 2026.
- CMS finalized a 3.1% payment rate for ASCs.
- CMS added 11 nondental procedures to the ASC-covered list that were not included in the proposed rule.
Hurting
- CMS finalized a 3.37% Medicare physician fee cut for 2024. However, Congress released a $460 billion spending package that would temporarily halve the Medicare pay cut for physicians to approximately 1.7%.
- The estimated Medicare ASC payments for five of the top ASC codes performed in 2023 are projected to fall in 2024.