CMS Releases Final Rule for New ASC Payment System

CMS on Nov. 1 released its highly anticipated final rule establishing the payment rates for services provided in ASCs in 2008. This finalizes the proposed rule that was issued in August as a companion to the final rule initially overhauling the Medicare ASC payment system. The effect of the latest final rule is twofold: It delineates payment rates for ASCs and HOPDs and establishes the first payments determined using the new payment system finalized in August.

Here's a look at the specifics:

• In 2008, ASCs will generally be paid 65 percent of HOPD rates, as was proposed in August. Due to an inflationary update, CMS estimates Medicare payments for outpatient services will increase overall by an average of 3.8 percent in CY 2008.

• Eight-hundred-nineteen more procedures will be payable in the ASC setting, for a total of 3,390. "FASA and its members have been saying that some of these procedures, like laparoscopic cholecystectomies, should have been included on the list even under the old criteria," writes the organization. "Although ASCs were unsuccessful in convincing CMS to add these and many other procedures under the old criteria, the new process and the new criteria resulted in their addition to the list."

• There will be a four-year implementation period to give ASCs more time to adjust; newly added procedures will be established at full payments on Jan. 1.

• Forty-five procedures designated as "device-intensive" will be paid at more than 65 percent of HOPD rates, and procedures performed more than 50 percent of the time in physicians offices will be capped at the lesser of either 65 percent of HOPD rates or the global fee Medicare pays physicians to perform the procedures in the office setting.

A complete list of additions and deletions; a breakdown of the 2008 national ASC rates and what the rates would be if fully transitioned in 2008; a rate calculator to determine local payments; information regarding a special audioconference on implementing the new rates; and other materials to assist FASA members in analyzing their 2008 payments are available at FASA's Web site and at AAASC's Web site.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.