CMS Issues 2015 Proposed Payment Rule for Ambulatory Surgery Centers

The Centers for Medicare & Medicaid Services (CMS) has released the 2015 proposed payment rule for ambulatory surgery centers (ASCs).

View the 2015 ASC payment proposal (pdf).

As the ASC Association notes, positive news for ASCs from the proposal includes CMS proposing to add 10 new spine procedures to the ASC list of payable procedures. Another piece of positive news is CMS proposing to define ASC device-intensive procedures as procedures assigned to any APC with a device offset percentage greater than 40 percent as based upon the standard Outpatient Prospective Payment System APC rate-setting methodology. The previous threshold was 50 percent.

But the proposed rule also included some discouraging news for ASCs. CMS elected to continue using the Consumer Price Index for All Urban Consumers to update ASC rates while using what the ASC Association describes as the "more appropriate" Hospital Market Basket cost measure to update hospital outpatient department rates. By using these different measures, CMS is proposing an effective payment update of 1.2% for ASCs and an effective payment update of 2.1% for HOPDs.

ASCs facing tightening margins due to reimbursement declines and increasing costs cannot afford to leave any money on the table. To ensure you receive the appropriate reimbursement for the procedures your ASC's physicians perform, consider outsourcing your ASC billing to PGM Billing. PGM is a veteran firm with more than 30 years of coding and billing experience. Its team of certified billers is well versed in billing for ASCs of all sizes and for all ASC specialties.


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