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Final CMS ruling generally grants ASCs 65% of the hospital outpatient department rate
The rule also adds more than 800 procedures to the ambulatory surgical center list for Medicare reimbursement.
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Provisions of a final rule announced by the Centers for Medicare & Medicaid Services on Nov. 1 detail payment rates for ambulatory surgical centers for 2008 using the revised payment system that will result in the facilities receiving 65% of the hospital outpatient reimbursement.
Under the hospital outpatient prospective payment system (OPPS) final rule for 2008, Centers for Medicare & Medicaid Services (CMS) will implement the use of composite Ambulatory Payment Classification (APC) groups, which allows for one bundled payment for many procedures.
"Composite APCs encourage even greater hospital efficiencies than expending packaging by making a single payment for the totality of hospital outpatient care provided during an encounter," according to a CMS press release.
In general, ASCs will receive 65% of the hospital outpatient department (HOPD) rate for services provided in 2008, according to information obtained from the Federated Ambulatory Surgery Association (FASA).
However, procedures frequently performed in physician offices will be paid less than 65% of the HOPD rate. For 45 device-intensive procedures, ASCs will receive the HOPD amount for the device and "only the remainder of the APC reimbursement will be discounted to 65% of the HOPD rate," according to the FASA.
The ruling also adds more than 800 procedures to the ASC list for Medicare reimbursement, including treatment of humeral fractures and revisions of the knee joint.
The revised ASC payment system includes a 4-year transition period for current procedures on the payment list. "Newly added procedures will transition to the full payments established under the new ASC payment system immediately," according to FASA.
"The policies of the revised ASC payment system that are reflected in the 2008 payment rates further expand beneficiary choices by providing patients the flexibility to select, in consultation with their physicians, the most appropriate care setting for their particular surgical needs," the acting administrator for CMS, Kerry N. Weems, wrote in a CMS press release.
"The revised system takes a major step toward eliminating financial incentives for choosing one care setting over another, thereby placing patients' needs first, increasing efficiencies and leading to savings for both beneficiaries and the Medicare program," he said.