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4 biggest payer moves this month

Payers are incentivizing physicians to perform procedures in low-cost settings, which means ASCs are becoming increasingly attractive. At the same time, physicians are balking at some payer moves in the last 30 days.

Four of the biggest payer moves this month for ASCs:

1. Physicians face another year of fee cuts in 2023 as Medicare proposes to reduce the conversion factor by 4.42 percent to $33.08. Many physicians are pushing back against the proposed cuts, arguing that continued cuts to the physician fee schedule would create long-term financial instability within the program and threaten patient access to Medicare-participating physicians.

2. Medicare is recommending removing 10 procedures from the inpatient-only list in 2023, according to its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule, released July 15.

3. Cigna is delaying the implementation of its modifier 25 policy. The reimbursement policy requires the submission of medical records with all evaluation and management claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. 

4. Aetna will no longer require prior authorization for cataract surgery or video electroencephalography procedures. For spinal fusion and cervical artificial disc surgeries, Aetna will no longer require precertification for the site of service. The surgeries still need to be precertified.

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