2008 ASC Final Rule

August 4th, 2007 | Medicare | Regulatory Matters

CMS published the Final Rule for the new Ambulatory Surgery Center payment system pegged to the Hospital OPPS rates, using a factor of 67% versus the 62% contained in the 2006 Proposed Rule.  Although the payments will be somewhat better than originally thought, the 5% spread is not indicative of the true difference because certain required adjustments have not yet been made.  One big winner in the Final Rule was the payment for cataract surgery, which was set at 8% higher than in the proposed rule and nearly 4% higher than the present payment.

Despite being pegged at the outset to OPPS rates, future increases in ASC rates will be based on the CPI for Urban Consumers while OPPS rate increases are based upon a separate "market basket" of cost inputs for hospital outpatient departments.  The market basket is usually higher than the CPI.

The new rates were supposed to be implemented using a 50-50 split with the old rates in 2008 and full implementation in 2009.  The Final Rule changed this to a 4-year phase-in using a 25-75, 50-50, 75-25 schedule.  Thus, those procedures who would lose under the new payments will lose less and those who would benefit will benefit less.

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