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CMS proposes adding total knee replacements to ASC covered procedures list for 2020, increases payment rates

CMS released its 2020 outpatient and ASC prospective payment system proposed rule, ushering in several changes for ASCs and hospital outpatient departments.

Four things to know:

1. CMS proposed adding total knee arthroplasty to the ASC covered procedures list, along with knee mosaicplasty and three coronary intervention procedures . CMS is seeking comment on potential limitations that should be set on performing total knee arthroplasty or other proposed procedures in ASCs, as well as feedback on how the ASC covered procedures list could be redesigned to expand physicians' ability to choose the appropriate setting of care for their patients. Comments are due to CMS Sept. 27.

2. CMS also proposed removing total hip arthroplasty from the inpatient only list, making the procedure eligible for Medicare reimbursement in the hospital outpatient and inpatient setting.

3. CMS finalized its proposal to apply the hospital market basket update to the ASC payment system for five years and proposed to update ASC payment rates for 2020 by 2.7 percent for ASCs that meet quality reporting requirements. CMS said the change is intended to promote site neutrality and encourage the shift of outpatient procedures from HOPDs to ASCs.

4. CMS didn't remove any measures from the ASC quality reporting program for 2020 but did propose adopting a claims-based measure in 2024 for seven-day hospital visits after general surgery procedures performed in ASCs.

“We are grateful that this proposed rule continues the sound policy of updating ASC Medicare payments for inflation on par with hospital outpatient departments," said Ambulatory Surgery Center Association CEO Bill Prentice in a statement. “In addition, proposing to add total knee arthroplasty to our procedures list so soon after moving it from the inpatient-only list speaks well to the confidence that CMS has in the ability of physicians to use well-established patient selection criteria to move appropriate patients to the lower-cost ASC setting."

Read more here.

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