REGULATORY REVIEW


Medicare Payment Policy Gains from the Past Decade ASCA advocacy bears fruit BY KARA NEWBURY


ASCA works with all federal regulators that have an impact on ASC operations, but its recent efforts have focused pri-


marily on the Centers for Medicare & Medicaid Services (CMS). Pay- ment policy is often at the top of the priority list. Private payers often fol- low Medicare’s lead when determin- ing which procedures are reimbursed and how to reimburse for devices, and these payers often use Medicare rates as a basis for negotiating rates. As a result, Medicare payment poli- cies that support ASCs are critical to the viability of our industry, and ASCA has achieved important prog- ress in this area over the past decade.


Procedure List As part of its advocacy program, ASCA spends a lot of time urging CMS to add procedures to the ASC Covered Procedures List (ASC-CPL). Since 2013, CMS has added 360 procedures that were previously reimbursed only in hospitals to the ASC-CPL.


CMS has no set process for sub- mitting codes for approval, no form to fill out and no set meeting to attend. The agency has been responsive to ASCA and various specialty groups, industry leaders and organizations when they proactively brought indi- vidual procedures to it for review on a piecemeal basis. ASCA uses trends found in the annual procedure list survey it sends to members to deter- mine the codes to pursue and brings surgeons to the CMS medical offi- cers to present on the safety of spe- cific codes. Although this process is time-consuming, it has been the most successful way to get codes added to the ASC-CPL.


16 ASC FOCUS AUGUST 2021 | ascfocus.org


Eight Years of ASCA Advocacy 2013 and 2014: ASCA held two meet- ings with CMS staff specifically to discuss the addition of spine codes to the ASC-CPL. The meeting in 2013 took place after the proposed rule was released. Adding codes between the proposed and final rules is typically more difficult than adding them when CMS proposes them for addition from the beginning. In 2014, ASCA met with CMS staff earlier in the spring, and its efforts were rewarded with spine codes being included in the 2015 proposed rule. ASCA called upon its members to provide positive feedback to CMS regarding the volume and out-


comes of these spine codes being done in their facilities. As a result, CMS finalized nine spine codes in the 2015 Hospital Outpatient Prospective Pay- ment System (OPPS)/ASC final rule.


2015: Although ASCA’s efforts were fruitful in 2014, it did not get all the requested spine codes added to the ASC-CPL. In 2015, ASCA went back to CMS to discuss other spine codes that should be payable in ASCs. Due in large part to ASCA advocacy, CMS added 17 codes to the ASC-CPL for 2016, mostly spine codes.


2016: In 2016, ASCA focused its efforts on total joints, starting with total knee


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