CMS proposed several updates to ASC payments in the 2019 proposed payment rule, issued July 25. One of the key changes for ASCs would be to broaden the definition of device-intensive procedures, adding around 131 procedures for Medicare beneficiaries in the ASC setting.
Here are five things to know:
1. CMS proposed updating the definition of device-intensive procedures from procedures where the device is 40 percent of the overall cost to 30 percent of the overall cost for the procedure in the hospital outpatient department.
2. The lowered threshold is expected to make it economically possible for ASCs to be able to provide 131 device-intensive procedures to Medicare beneficiaries for the first time. "[This is] a policy change we have been advocating for over the past several years to encourage migration of these procedures into ASCs," said ASCA CEO William Prentice in a Q&A posted on the organization's website.
3. The new definition of device-intensive would increase the number of device-intensive procedures that ASCs can afford to provide to Medicare beneficiaries from 154 to 285 procedures for 2019, if it appears in the final rule.
4. Among the newly approved cases would be several cardiac procedures. The proposed payment rule would also revise the definition of "surgery" for ASC payments to include "surgery-like" procedures, which would add 12 cardiac catheterization procedures to the ASC list as well.
5. For device-intensive procedures, the total cost of the device is included in the reimbursement rate for ASCs.