Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

2018 Medicare ASC Payment System Update

ASC Payment System

The Centers for Medicare and Medicaid Services recently released the final rule of the 2018 Ambulatory Surgical Center (ASC) Payment System, giving ASCs a payment increase of 1.2 percent. The policy update also adds three new procedures to the list of covered procedures, as well as making changes to the ACS Quality Reporting program.

The ASC payment update was calculated by subtracting a .5 percent multi-factor productivity (MFP) adjustment from the 1.7 percent Consumer Price Index for all urban consumers (CPI-U). After factoring in enrollment, case-mix, and utilization changes, CMS estimates that total ASC payments will increase 3 percent in 2018.

New ASC Covered Procedures

Three new ASC procedures were approved for the 2018 ASC covered procedures list (CPL), including the following:

  • 22856: Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical.
  • 22858: Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (list separately in addition to code for primary procedure).
  • 58572: Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250g.

In addition, CMS solicited comments on whether total knee arthroplasty, partial hip arthroplasty, and total hip arthroplasty could meet the criteria to be added to the ASC-CPL. Those procedures were all proposed to be removed from the Outpatient Prospective Payment System list of inpatient-only codes. CMS suggested that if they were approved for outpatient payment, then they might be approved for payment at an ASC. Once finalized, CMS ended up removing only codes 27447 (Arthroplasty, knee, condyle and plateau; medical and lateral compartments with or without patella resurfacing (total knee arthroplasty)) and 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) from the OPPS IPO list for 2018. CPT codes 27125 (Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)) and 27130 (Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft) were not removed from the OPPS IPO list, and none of the four procedures was added to the ASC-CPL.

ASC Quality Reporting Program Updates

For the ASC Quality Reporting Program, CMS finalized the addition of two new measures for the 2022 payment determination and subsequent years:

  • ASC-17: Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures (beginning with the CY 2022 payment determination).
  • ASC-18: Hospital Visits after Urology Ambulatory Surgical Center Procedures (beginning with the CY 2022 payment determination).

Both of these new measures will be evaluated using the administrative claims process, and thus will not add any submission responsibilities to providers.

Another proposed measure, ASC-16: Toxic Anterior Segment Syndrome (TASS) measure (beginning with the CY 2021 payment determination), was not finalized. As well, three measures have been removed for the CY 2019 payment determination and subsequent years, including,

  • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing.
  • ASC-6: Safe Surgery Checklist Use.
  • ASC-7: ASC Facility Volume Data on Selected Procedures.

“Removal of these measures would alleviate maintenance costs and administrative burdens to the ASCs, resulting in a burden reduction of 1,314 hours and $48,066 with respect to requirements for the CY 2019 payment determination,” CMS representatives wrote in a fact sheet about the final rule.

Finally, a proposal to require ASCs to complete the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR Program has been delayed indefinitely.

For more information about the 2018 Ambulatory Surgical Center (ASC) Payment System, review the CMS fact sheet or the final rule in its entirety.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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