Medicare reform bill does not address ASCs

The Medicare reform bill recently passed by the U.S. House of Representatives would increase physician payments by 1.5% in 2004 and 2005 if enacted. But the bill so far leaves the issue of ambulatory surgery center payments unresolved.

The bill leaves a “place holder” for a compromise on Medicare payments to ASCs, since the issue was not resolved when the bill was passed, according to a press release from the American Academy of Ophthalmology.

MedPAC, an independent committee that advises Congress on Medicare payment issues, has called for a freeze on ASC payments during 2004, as well as reductions in payments for certain ASC procedures. Under MedPAC’s plan, reimbursement for key ophthalmologic procedures would be cut. Payment for Nd:YAG capsulotomy, for instance, would decrease from $446 to $223 under the MedPAC plan, according to the AAO.

The place holder in the current House bill would give administrators time to work out a compromise on the ASC payment issue with the Centers for Medicare and Medicaid Services.

A proposed change to the current CPT coding system is another problem with the House bill, the AAO news release indicated. If kept as part of the current bill, physicians could be required to change from using the current 8,000 code CPT system to more than 170,000 codes.

The Senate Medicare reform bill, also already passed, increases Medicare payments to physicians in rural areas that may currently be below the national average. Of interest to ophthalmologists is the Medicare Vision Rehabilitation Services Act portion of the bill, which makes low-vision rehabilitation services available through all Medicare carriers.