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CMS proposes 1.2% ASC payment increase in 2017: 9 key points

CMS released its 2017 Medicare Outpatient Prospective Payment System proposed rule, which aims to enhance Medicare patients' quality of care.

Here are nine key points:

1. Based on the policy changes in the proposed rule, CMS projects ASC payments would increase 1.2 percent.

2. For 2017, CMS proposes a 1.55 percent increase in OPPS rates. After considering policy changes included in the proposed rule, CMS estimates the OPPS payments would increase by 1.6 percent. Policy changes and updates include a positive 2.8 percent market basket update, a negative 0.5 percent update for productivity adjustment and a negative 0.75 update for cuts under the Affordable Care Act.

3. For compressive ambulatory payment classifications, CMS is proposing adding 25 new C-APCs, with the majority designated as major surgery APCS within existing C-APC clinical facilities.

4. CMS proposes adding three clinical facilities to help new C-APCs including:

•    Nerve procedures, excision, biopsy, incision
•    Drainage procedures
•    Endoscopy procedures

5. CMS is proposing a C-APC for Bone Marrow Transplants. The classification would allow ambulatory payments to package all services' costs on the same OPPS into the BMT's rate setting.

6. CMS is proposing a change to calculate the device offset amount at the HCPCS code level, as opposed to the APC level. Through the change, CMS' aim is to assign all device-intensive procedures that surpass the 40 percent threshold device-intensive status. Hospital outpatient departments and ASCs are paid the same for a device-intensive procedure's device portion.

7. In the rule, CMS proposed implementing Section 603 of the Bipartisan Budget of 2015's site-neutral payments, which mandates that various items and services which off-campus provider-based departments offer should not be characterized as covered outpatient department services for OPPS payments. Rather, starting Jan. 1, 2017, CMS would pay such facilities under other applicable Medicare Part B payment systems.

8. In response to CMS' proposed rule, American Hosptial Association's Tom Nickels, executive vice president of government relations and public policy, said, "Hospitals and health systems and more than half of the House and the Senate requested that CMS provide reasonable flexibility when implementing Section 603 of the Balanced Budget Act of 2015 in order to ensure that patients have continued access to hospital care. Instead, the agency is actually proposing to provide no funding support for outpatient departments for the services they provide to patients. This does not reflect the reality of how hospitals strive to serve the needs of their communities. In addition, CMS' refusal to continue current reimbursement to hospitals that need to relocate or rebuild their outpatient facilities in order to provide needed updates and ensure patient access is unreasonable and troubling."

9. CMS will accept comments on the proposed rule until Sept. 6.

More articles on coding & billing:
7 ways ASCs can improve billing, coding for spine and pain management
When trying to enroll in healthcare plans, young adults face opposition — 5 things to know
Cigna & Hill Physicians Medical Group team up to deliver coordinated care— 5 points

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