CMS proposes 2.7% update to ASC pay rate in 2023: 6 things to know

CMS on July 15 released its 2023 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule, which includes updates to ASC payment rates, the inpatient-only list and ASC covered-procedures list.

Six things for ASCs to know:

1. CMS is proposing to update ASC payment rates by 2.7 percent in 2023. The proposed update, which applies to ASCs that meet certain quality reporting requirements, is based on the projected hospital market basket percentage increase of 3.1 percent reduced by 0.4 percentage point for the productivity adjustment. In 2019, CMS began applying the productivity-adjusted hospital market basket update to ASC payment system rates for an interim period of five years: 2019-2024.

2. For 2023, CMS is proposing to remove 10 services from the inpatient-only list and adding one procedure, a lymph node biopsy or excision, to the ASC covered-procedure list.

"This proposed rule misses an opportunity to lower costs and improve access to care to beneficiaries by not adding many viable procedures that ASCs are safely performing on commercial patients," Bill Prentice, CEO of the Ambulatory Surgery Center Association, said in a July 15 news release. "We have provided clinical data to CMS that should be used to add these procedures to our allowable list for 2023."

3. CMS said it believes using claims data from 2021, with cost reports data through 2019, is the best estimation of expected costs for 2023 hospital outpatient services for rate-setting purposes. As a result, CMS is proposing using 2021 claims data with cost report data through 2019 to set ASC payment system rates for next year.

4. CMS is changing the "nominations" process to the "pre-proposed rule [covered-procedure list] recommendation” process and proposes to change the start date of this process from Jan. 1, 2023, to Jan. 1, 2024, so external parties can recommend a procedure by March 1 of a calendar year for the ASC-CPL for the following calendar year. 

5. The agency is also proposing a new ASC payment policy that would result in higher payment when a code combination is a more complex and costlier version of the procedure performed, "similar to the way in which the OPPS APC complexity adjustment is applied to certain paired code combinations that exhibit materially greater resource requirements than the primary service." 

6. In relation to the ASC Quality Reporting Program, CMS is proposing to suspend the mandatory adoption of ASC-11 (cataracts: improvement in patient’s visual function within 90 days following cataract surgery) and is requesting comments on the potential readoption of ASC-7 (ASC facility volume data on selected ASC surgical procedures or another volume indicator in the ASCQR program.)

The proposed rule has a 60-day comment period, which will end on Sept. 13. The final rule will be issued in early November.

To read the 886-page proposed rule, click here.

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