Becker's Spine Review

38 ASC CMS finalizes 2022 rules with 255 procedures removed from ASC-payable list By Alan Condon CMS on Nov. 2 finalized the Outpatient Prospective Payment System and ASC Payment System final rule for 2022. What you should know: 1. In 2022, CMS updated ASC payment rates by 2 percent for centers that meet applicable quality reporting requirements. e move follows a section of the 2019 OPPS/ASC final rule that agreed to apply the hos- pital market basket update to ASC payment rates through 2023. 2. e agency also updated outpatient payment rates for hospitals that meet certain quality reporting criteria by 2 percent. CMS said the up- date is based on the projected hospital market basket increase of 2.7 percent and reduced by 0.7 percent for the productivity adjustment. 3. Due to a number of COVID-19 public health-related factors, CMS said 2020 claims data are not the best approximation of expected out- patient hospital services in 2022. Instead, CMS believes that 2019 data — the most recent year prior to the pandemic — are a better approx- imation of expected costs for rate-setting purposes this year. ere- fore, the agency is generally using 2019 claims data to set the 2022 Outpatient Prospective Payment System and ASC payment rates. 4. CMS finalized its proposal to halt the elimination of the inpa- tient-only list and return the list of services removed from the list in 2021, excluding CPT codes 22630 (lumbar spine fusion), 23472 (reconstruct shoulder joint), 27702 (reconstruct ankle joint) and their corresponding anesthesia codes. "is change in policy promotes transparency and ensures that any service removed from the IPO list has been reviewed against Medi- care's long-standing IPO criteria to determine if it is appropriate for Medicare to pay for the provision of the service in the outpatient set- ting," the agency said. 5. In the 2021 OPPS/ASC final rule, CMS enacted a policy in which procedures removed from the IPO list beginning Jan. 1, 2021, would be indefinitely exempted from certain medical review activities related to its two-midnight rule, which states that inpatient admission and pay- ment are appropriate when the treating physician expects the patient to require a stay that crosses two midnights and admits the patient based on that expectation. is change was made to accommodate the num- ber of procedures being removed from the IPO list in 2021. But, as CMS is halted its elimination of the IPO list, the agency also finalized a proposal to revise the exemption for procedures removed on or aer Jan. 1, 2021, from the IPO list to the exemption period that was previously in effect — a two-year period. 6. is year, CMS reinstated its 2020 criteria for adding procedures to the ASC covered-procedures list. CMS requested comment on whether any of the 258 procedures proposed for removal from the covered-pro- cedures list met the 2020 criteria. It received 140 procedure recommen- dations, including new procedures and procedures that were already on the covered-procedures list and not proposed for removal. 7. Following a review of these recommendations, CMS keept six pro- cedures — three that were already on the ASC covered-procedures list and three proposed for removal — and removed 255 of the 258 procedures proposed for removal. e three codes that were proposed for removal and that were re- tained are: • 0499T: Cystourethroscopy, with mechanical dilation and ure- thral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed • 54650: Orchiopexy, abdominal approach, for intra-abdominal testis (e.g., Fowler-Stephens) • 60512: Parathyroid autotransplantation 8. Beginning in March, a process will be adopted to allow an external party — particularly specialty societies that are familiar with proce- dures in their specialty — to nominate a procedure to be added to the ASC covered-procedures list. If CMS determines that a procedure meets the requirements to be added to the list, it would propose to add the procedure to the list for Jan. 1, 2023. n OIG says physician-owner can profit from employed CRNA performing anesthesia in ASC By Patsy Newitt A physician-owner of a pain management practice can profit from an employed certified registered nurse anesthetist providing anes- thesia services in an office and ASC partly owned by the physician, according to a OIG advisory opinion discussed in a Nov. 19 report from JD Supra. Here are four things to know: 1. The OIG found that if the CRNA was employed by the pain management practice, the salary payments were protected by employment safe harbor, according to the report, filed by the law firm Bass, Berry & Sims. 2. The arrangement is protected under the federal An- ti-Kickback Statute because the CRNA reassigned the right to receive reimbursement for the anesthesia ser- vices to the physician-owner. The practice then assumes responsibility for the CRNA's performance of anesthe- sia services. 3. The agency also noted that the arrangement is "com- monplace practice in the healthcare industry." n

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