What ASCs should expect from CMS' payment rule changes

Two experts from ECG Management Consultants discussed what changes to the 2019 Outpatient Prospective Payment system and ASC Payments systems could mean for ASCs.

Four things to know:

1. Rate calculation for ASCs and HOPDs is on the same update factor. Previously, ASC reimbursement was based on the consumer price index for urban consumers. Given that the hospital rate was higher than ASC rates, the new rates could mean an increase in reimbursement for ASCs

2. The device-intensive code offset threshold has been reduced. Procedures that involve a single-use device are now eligible as device-intensive procedures, lowering the offset percentage threshold from 40 percent to 30 percent, meaning more device-intensive surgeries could migrate to lower-cost ASC settings.

3. CMS is reimbursing Exparel in ASCs. CMS will give separate payments for nonopioid pain management drugs, opening the door for ASCs to use Exparel for patients on Medicare.

4. CMS modified the definition of surgery. CMS' decision to change its definition of surgery expanded the number of procedures on the ASC-approved list, adding 17 cardiac catheterization procedure codes to the list. With the change, ASCs may be able to perform more high-volume and cardiac-focused procedures.

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