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REGULATORY REVIEW


ASCA Advocacy Bears Fruit in 2020 Payment Rules CMS policy changes affect ASCs and physicians BY KARA NEWBURY AND ALEX TAIRA


The Centers for Medicare & Medicaid Ser- vices (CMS) released its


2020 hospital outpatient prospective payment system (OPPS)/ASC final pay- ment rule in November 2019. The rule finalizes the addition of eight codes, including total knee arthroplasty (TKA), to the ASC-payable list. CMS also recon- firmed its decision to continue to align the ASC update factor with the factor used to update hospital outpatient depart- ment (HOPD) payments through CY 2023 as the agency assesses this policy’s impact on volume migration.


Conversion Factor After years of advocacy efforts, in 2019, ASCA and key stakehold- ers were successful in convincing CMS to use the hospital market bas- ket (HMB) instead of the Consumer Price Index for All-Urban Consumers (CPI-U) to update ASC payment rates annually. The CPI-U had been the default for more than a decade, since the ASC and HOPD payment systems were aligned. ASCs’ reimbursements, on average


over all covered procedures, received an effective update of 2.6 percent, a combination of a 3.0 percent inflation update based on the HMB and a pro- ductivity reduction mandated by the Affordable Care Act of 0.4 percent- age points. Because this is an aver- age, updates will vary, sometimes sig- nificantly, by code and specialty. The final conversion factor for ASCs is $47.747 and $80.784 for HOPDs. The ratio of these conversion factors is 59.1 percent, which is slightly higher than the ratio in the proposed rule.


18 ASC FOCUS FEBRUARY 2020 | ascfocus.org


ASC Weight Scalar As noted above, CMS is evaluating whether the change to the HMB will drive volume to the lower-cost ASC set-


MAKE REGULATORY COMPLIANCE EASIER


Take advantage of ASCA’s free, members-only Medicare payment resources, including analyses of Medicare’s proposed and final payment rules and ASCA’s proprietary Medicare Rate Calculator. ASCA members can use this valuable tool to find the exact proposed national and local payment rates for any code by inputting their center’s state and county.


ascassociation.org/ medicarepayments


ting before making the HMB the perma- nent update factor for ASCs. Unfortu- nately, another policy—the ASC weight scalar—needs to be fixed before CMS will achieve the migration it desires. ASCA’s top advocacy push for 2021 is the removal of the ASC weight scalar. The ASC weight scalar is a weight scaling adjustment that CMS uses to maintain ASC budget neutrality. The agency, however, is trying to maintain budget neutrality—containing costs year over year—in silos instead of across payment systems. That means that if vol- ume were to be driven to the ASC, rates would eventually go down to keep pay- ments within the system steady. In 2009, the ASC weight scalar resulted in a 2.5 percent cut to the ASC weights, which are used to calculate reimbursement rates. In 2020, the ASC


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