New payment system to be proposed for ambulatory surgery centers
New payment system to be proposed for ambulatory surgery centers
Instead of waiting for the Centers for Medicare & Medicaid Services (CMS) to develop a new reimbursement system for outpatient surgery, ambulatory surgery associations have taken the initiative and developed legislation proposing their own ideas for a revamped system.
The Ambulatory Surgical Center (ASC) Payment Modernization Act (HR 4042) would develop a list of procedures that ASCs will not be paid for, rather than the current system of determining what procedures they will be paid for. Also, the criteria for determining which procedures will be reimbursed would be changed to the following:
- Is it safe to perform in an ASC?
- Can it be performed without an overnight stay?
These criteria were the ones recommended by the Medicare Payment Advisory Commission (MedPAC), according to the Federated Ambulatory Surgery Association (FASA). If the answer to either question is no, Medicare would not pay an ASC for performing the procedure.
"These two changes should significantly expand Medicare beneficiaries’ access to ASCs," FASA said in a released statement.
The bill would set the ASC reimbursement rate at 75% of the hospital outpatient department (HOPD) rate. ASCs would receive pass-through payments for the additional costs of innovative medical devices, drugs, and biologicals, as well as other additional payments that hospitals receive, except for outliers and direct medical education (DME) payments. ASCs would receive annual updates and other adjustments, such as wage indices, just as hospitals do.
The beneficiary’s copayment for services furnished in the ASCs would be 20% of the Medicare payment amount, as it is now. In contrast, HOPD copayment obligations vary and can exceed 40%, FASA says. The new payment system would be phased in over four years, and it generally would apply a blend of existing ASC and HOPD rates, FASA says. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires CMS to implement a new ASC payment system by Jan. 1, 2008.
Rep. Wally Herger (R-CA) introduced the proposed legislation. Like most legislation, it faces an uphill battle, says Kathy Bryant, executive vice president of FASA.
"ASCs need to educate members of Congress as to how ASCs can save Medicare and its beneficiaries money while providing first-class care," Bryant says. "If enacted, this bill offers many benefits: for Medicare beneficiaries, greater access to services at lower out-of-pocket costs; for the federal government, greater savings; and for ASCs, certainty for the future, a more stable payment system, and a more reasonable method for determining what procedures Medicare reimburses."
Instead of waiting for the Centers for Medicare & Medicaid Services (CMS) to develop a new reimbursement system for outpatient surgery, ambulatory surgery associations have taken the initiative and developed legislation proposing their own ideas for a revamped system.Subscribe Now for Access
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