CMS has made several policy changes this year that have shifted the ASC market, affecting issues such as prior authorization, reimbursement and billable procedures.
Below are four changes made by CMS in 2024:
1. The agency added 11 procedures to the ASC-payable list at the beginning of the year that were not originally included in its proposed fee schedule for 2024.
2. Though CMS reduced physician pay by 3.4%, updating the conversion factor to $32.74, Congress released a $460 billion spending package in March that would halve 2024's 3.4% Medicare pay cut for physicians to approximately 1.7% — but only temporarily. The reduction to the pay cut would only remain in effect until Jan. 1, 2025.
3. It updated prior authorization regulations 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, requiring 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, as well as make decisions within 72 hours for expedited requests and seven calendar days for standard requests by 2027.
4. The agency piloted a program in wake of the Change Healthcare cyberattack in February to expedite payments to Medicare Part A providers and advance payments to Part B providers affected by the outage, which caused an estimated $100 million daily impact on the healthcare industry.
CMS said it will no longer accept requests for advanced payments after July 12, having provided $2.55 billion in advanced payments to 4,200 Medicare Part A providers and $717.2 million in payments to Part B providers since the program's launch.