CMS could increase ASC reimbursement by 2.6% — 5 insights

CMS released its proposed hospital outpatient payment rule for 2021 that would increase ASC reimbursement rates about 2.6 percent if approved as drafted.

What you should know:

1. The inflation update factor is about 3 percent, which after the ACA's productivity reduction equals about 2.6 percent for both ASCs and hospital outpatient departments.

2. The proposed ASC conversion factor is $48.984 to the proposed hospital outpatient department conversion factor of $83.697.

3. CMS also seeks to add 11 codes to the ASC covered procedure list, notably including total hip replacement.

4. CMS also plans to transition codes off the inpatient-only list over the next three years, with a goal to eliminate the list completely by 2024.

5. Ambulatory Surgery Center Association President Bill Prentice chided certain aspects of the proposal. He said, "We remain concerned that, while this proposal explains the negative effect that the use of weight scaling has on ASC rates, it does not take the needed steps of addressing it."

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