Are you keeping up to date on new ASC legislation? Staying current on recent and upcoming billing and coding changes can help your ASC maximize reimbursements and avoid unnecessary financial penalties.
Full Speed Ahead: Advocating for the Nationwide ASC Community
As a member of the Ambulatory Surgery Center Association (ASCA), in2itive is on a mission to keep the ASC community top of mind when it comes to decisions regarding funding, reimbursements, and other essentials to your bottom line.
We participated with other ASC leaders and associations at the National Advocacy Day event in Washington D.C. This key event provided an opportunity for direct access to the policymakers responsible for the critical decisions impacting the ASC community as a whole.
“The ASCA organization has done a tremendous job of positioning ASCs and their interests well on the national political stage. The legislation they have helped to generate benefits the interests of ASCs, patients and third-party payers nation-wide. We remain optimistic about the growing role ASCs can play in our healthcare ecosystem.” – Hannah Hagan
Among the many pieces of legislation in the works, the Outpatient Surgery Quality and Access Act H.R. 972 / S. 312 which will ensure Medicare beneficiaries’ continued access to high-quality outpatient surgery was top of mind. This bill would align the reimbursement update factor for identical outpatient procedures, add an ASC representative to the Advisory Panel on Hospital Outpatient Payment, eliminate the copay penalty for Part B services, among other provisions.
Deciphering the 2023 ASC Payment System
The Centers for Medicare and Medicaid Services (CMS) recently released the ASC Payment System Final Rule for 2023. This includes updated payment rates as well as new reimbursement and coverage policies. Among the many changes and updates, the three key billing shifts to keep tabs on are:
- 2023 ASC Payment Update. CMS increased the payment rate to 3.8%, based on the productivity-adjusted hospital market basket update.1 This is projected to increase total ASC payments by $230 million to an estimated $5.3 billion in 2023.1
- Ambulatory Surgical Center Quality Reporting (ASCQR) Program. Meeting the requirements of the ASCQR Program is critical for maximizing payments per the updated CMS final rule. This pay-for-reporting system promotes information transparency and serves to improve quality of care. ASCs that fail to meet the reporting requirements will lose 2.0 percentage points on their payment undated for that same year.1
- 340B Drug Payment Update. The new payment rate for 340B drugs now aligns with the rate for drugs not purchased through the 340B program. CMS now pays the average sales price (ASP) plus 6% for these drugs.1 However, in order to balance costs, CMS reduced non-drug service payments by 3.09%.1
- Non-Opioid Medication Coverage. CMS is now covering five non-opioid drugs for pain management in the ASC setting.1 These drugs receive separate payment if they are FDA approved, indicated for analgesic purposes, and exceed the outpatient payment system (OPPS) drug packaging threshold.
Feeling overwhelmed by new billing policies?
You don’t have to navigate these changes alone — we’re here to help! Contact us today to learn how our certified ASC billing and coding experts can help your center stay on top of new requirements, close the gaps in your revenue cycle, and get paid in full. We’ll worry about the details so you can get back to what you do best: caring for your patients.
Feel free to check out our upcoming events. We’d love to connect with you and learn more about how we can work together to boost your bottom line.
Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating; COVID–19, 87 Fed. Reg. 71748 (November 23, 2022) (to be codified at 42 C.F.R. pts. 405, 410, 411, 412, 413, 416, 419, 424, 485, & 489).