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Physician pay cuts and a shrinking ASC-payable list: 12 key reimbursement updates

Here are the major reimbursement updates since July 1: 

1. Surprise bills for colonoscopies following a stool-based screening test with positive results are now prohibited. The Biden administration issued guidance requiring private insurers to cover these colonoscopies Jan. 10.

2. In November, CMS finalized 2022 Hospital Outpatient Prospective Payment System and ASC Payment System, which removed 255 procedures from the ASC-payable list.

3. In November, the Guardian, an implantable acute coronary syndrome event detector, qualified for CMS' transitional pass-through payment as part of the 2022 Medicare Hospital Outpatient Prospective Payment System.

4. CMS plans to cut physician pay by 9 percent in 2022, while costs to run an independent practice continue to rise.

5. In November, CMS created a new CPT code to describe the procedure associated with the EnPlace system, a minimally invasive meshless approach for pelvic floor fixation.

6. In November, one week after CMS finalized the 2022 rules and reimbursement rates, the agency released an update raising the rate for closed-loop hypoglossal nerve stimulation, a sleep apnea procedure, by more than $7,000. 

7. In October, Carlsmed's patient-specific spine implant, Aprevo, received a transitional pass-through payment from CMS. This provides outpatient facilities with an incremental Medicare payment for procedures that use Aprevo.

8. In September, CMS said it will move forward with site-neutral pay initiatives for outpatient clinic visits for hospital services provided at off-campus facilities.

9. In September, UnitedHealth released a report that showed shifting routine outpatient procedures to ASCs can save commercially insured patients $684 on average per procedure.

10. In August, Anthem updated its medical policy to cover radiofrequency ablation, including a minimally invasive treatment of uterine fibroids.

11. In July, CMS passed a prior authorization requirement for cervical fusion procedures despite protest from several organizations.

12. Aetna began requiring that healthcare providers get preapproval for all cataract surgeries July 1.

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