5 ways CMS changes are affecting reimbursement for ASCs, anesthesia practices and providers

The symbiotic partnership between endoscopists and anesthesiologists could soon be at risk after CMS waived co-payment and deductible responsibilities for colonoscopy patients, according to an Anesthesia Business Consultants' letter.

Here's what you should know.

1. While ASA endoscopy codes provide the same basic value for all payers, endoscopists are facing downward pressure concerning payment. From 2016 to 2017, diagnostic colonoscopy payments declined 16.5 percent.

2. ABC expects non-facility hospital department services to drop in gastroenterology throughout 2017. The Outpatient Prospective Payment System no longer covers items and services furnished in an off-campus provider-based department. The Medicare Part B Physician Fee Schedule now covers them.

The Congressional Budget Office estimates that move will save approximately $9.3 billion over the next decade, resulting in reduced payments to gastroenterologists.

3. Gastroenterologists not performing moderate sedation will see further payment reductions. Gastroenterologists using anesthesia providers, "will see a reduction in physician work relative value units and office practice expense for most GI endoscopy procedures," ABC reports.

4. Using anesthesia professionals will see the value of major GI endoscopy procedures reduced by 0.10 relative value units. This figure is less than the 0.22 RVUs the American Medical Association predicted.

5. Reimbursement is not all trending downward, however. CMS preserved payment rates in anesthesia use with upper and lower gastrointestinal procedures for the time being. CMS will review the procedures in 2017.

ABC predicts less invasive procedures will emerge as reimbursement continues to drop.

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