Outpatient Facility Coding Alert

Published on Thu Dec 06, 2012 PDF

CMS final rule increases ASC payment rates, adds 25 procedures.

Ambulatory surgery center payment rates will increase by 0.6 percent in 2013, according to the Medicare 2013 Final Rule from CMS. The slight uptick is better than a loss, but not as encouraging as the 1.3 percent increase slated in the original proposed rule.

Figures explained: The increase is based on the 1.4 percent projected rate of inflation and a 0.8 percentage point decrease for productivity adjustment required by the Affordable Care Act. The proposed rule factored in a 2.2 percent inflation rate minus a 0.9 percentage point productivity adjustment.

Hospital outpatient departments, by contrast, will receive a 1.8 percent increase.

Industry insiders such as Bill Prentice, CEO of the Ambulatory Surgery Center Association, are disappointed in the rates.

“Using different update factors for ASCs and hospital outpatient departments widens the gap between [hospital outpatient department] payments and ASC payments, further incentivizes a disturbing trend of conversions of ASCs to HOPDs [hospital outpatient departments], and increases costs to the Medicare program, its beneficiaries and taxpayers who support the program,” Prentice says.

Silver lining: ASCs will receive payment closer to HOPDs for device-intensive procedures that allow the ASC to be fully paid.

Add 25 Procedures to Your Approval List

CMS adds 25 additional procedures to the ASC payment list in 2013 (an improvement over the 16 proposed additions). Some examples of the new additions include:

Knee replacement update: CMS initially proposed removing knee replacement code 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]) from the “inpatient only” list for 2013. The Final Rule did not change the “inpatient only” status, so CMS will continue to only pay for the procedure when surgeons perform it in an inpatient setting.

Resource: The final rule can be viewed and downloaded from the ASC Regulations and Notices page of the CMS website. Details begin on page 979 of the downloadable PDF file.