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31 CODING & BILLING CMS 2018 Final Payment Rule Increases ASC Reimbursement 1.2%, Less Than Proposed: 5 Things to Know By Laura Dyrda C MS released the 2018 final payment rule for ASCs and hos- pital outpatient departments, both of which received lower reimbursement increases than proposed in July 2017, accord- ing to ASCA. Here are five things to know: 1. ASC payment rates increased 1.2 percent in 2018 based on a pro- jected inflation of 1.7 percent, minus a 0.5 percentage point produc- tivity adjustment required by the ACA. e adjustment falls short of the 1.9 percent proposed increase in July. e percentage increase varies by procedure, but the average update for ASCs is 1.2 percent. 2. HOPDs received a 1.35 percent increase in reimbursement, based on a 2.7 percent market basket update minus a 0.6 percent adjust- ment for economywide productivity, as well as a 0.75 percentage point adjustment, which is required by statute. In July, the proposed payment rule would have increased HOPD pay 1.75 percent. 3. ASCs and HOPDs are updated based on two different inflation- ary factors, which accounts for a portion in the reimbursement gap between the two settings. "Yet again, ASC payments fall farther behind those of hospital outpatient departments because CMS con- tinues to use an inflation factor — the CPI-U — that doesn't focus on the cost of goods and services in the healthcare market," said ASCA CEO William Prentice. "CMS insists on waiting for a perfect replacement to the CPI-U while a good one, the hospital market basket, is available." 4. CMS added three new procedures to the ASC payable list: cervi- cal artificial disc replacement, second level cervical disc replacement and total laparoscopic hysterectomy of the uterus over 250 grams. e agency removed total knee replacements from the inpatient-only list and plans to examine other joint replacement codes for removal in the future. However, CMS continues to exclude total knee and hip replacements as well as partial hip replacement from the ASC payable list because, as described by CMS, "our understanding is that these procedures typically require more than 24 hours of active medical care following the procedure." 5. For 2018, CMS updated the ASC Quality Reporting Program to include: • A delay for the mandatory Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey implementation under the ASCQR Program for 2018 data collection. • e removal of three measures from the 2019 payment deter- mination, including ASC-5: Prophylactic Intravenous IV Anti- biotic Timing; ASC-6: Safe Surgery Checklist Use; and ASC-7: ASC Facility Volume Data on Selective Procedures. CMS finalized two measures that are collected through claims for 2022 payment determination and subsequent years. ose measures are ASC-17: Hospital Visits aer Orthopedic Ambulatory Surgical Center Procedures and ASC-18: Hospital Visits aer Urology Ambu- latory Surgical Center Procedures. CMS did not finalize ASC-16: Toxic Anterior Segment Syndrome for 2021 and subsequent years payment determination. n "ASC payments fall farther behind those of hospital outpatient departments because CMS continues to use an inflation factor — the CPI-U — that doesn't focus on the cost of goods and services in the healthcare market." -William Prentice, ASCA CEO Call: 844-SUTURES info@eSutures.com • eSutures.com Over 1 million surgical items in stock and ready to ship same day!