Here are three updates on reimbursement issues and how they're impacting ASCs:
1. The enforcement of the No Surprises Act. On Sept. 13, U.S. Reps. Greg Murphy, MD, Raul Ruiz, MD, John Joyce, MD, Kim Schrier, MD, and Jimmy Pancetta introduced the No Surprises Act Enforcement Act. The bill aims to enforce the No Surprises Act by increasing penalties for non-compliance of statutory payment deadlines. The bill will create parity between penalties imposed against parties that are non-compliant with patient protection provisions and increase transparency of reporting requirements. This could lead to adjustments in how ASCs negotiate contracts with payers and structure their billing practices.
2. Reimbursements could keep declining next year. CMS released its annual proposed changes to the physician fee schedule for 2025 in July, which included a proposed 93 cent (2.8%) conversion factor drop from 2024. The proposed 2025 physician fee schedule conversion factor is $32.36, down from $33.29 in 2024.
3. Some specialties have seen more cuts than others. Sixteen specialties saw reimbursement declines in the last year, including psychiatrists, cardiologists, urologists, OB-GYN, internal medicine, internists, pulmonologists, radiologists, gastroenterologists and anesthesiologists.