The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that will, when final, govern ASC reimbursements in 2009. The rule has a comment period which ends September 2nd, 2008. The attached document “How to Comment on the 2009 Medicare Payment Rule” gives CMS’s instructions for submitting comments to the rule.
Summary
The proposed rule contains no major methodology changes from the current rule. Payments for most procedures will change slightly because of the Relative Weight adjustment that CMS performs each year. The expected transition to the new APC payment system continues. Overall, eight of 11 specialties tracked by the ASC Association will see an increase in payments while three have decreases. Ophthalmology and GI will continue to trend down with codes like 66984 dropping approximately 2% and 45380 dropping 6%.
Contrary to what CMS had previously discussed, the proposed rule does not require the implementation of any quality reporting measures. These are still expected in the future, however it is apparent that CMS is not prepared to move forward with ASC reporting in 2009.
Resources
The ASC Association has provided numerous resources on their website to help ASCs review the impact of the 2009 payment. We encourage you to review the proposed rule and payments and to contact GSASC and the ASC Association about changes that you would like to see. GSASC will be part of an industry-wide effort to submit comments on the proposed rule to CMS.
The CMS Proposed Rule - A copy of the rule from Medicare that includes the 2009 proposed ASC payments is available on the ASC Associations website here: www.ascassociation.org/09proposedpaymentrule.pdf
Rate Calculator – Calculate your proposed local payment rates. This calculator allows you to insert your proposed ASC wage index for 2009 and see the national payment rates, local payment rates, amount Medicare pays and the beneficiary copayment amounts for each procedures proposed to be payable effective January 1, 2009. www.ascassociation.org/calc09p.xls
List of Payable Procedures – This document contains the proposed list of payable procedures effective January 1, 2009, and corresponding national payment rate. www.ascassociation.org/list09p.pdf
Proposed ASC List Additions – This file Includes information about the 6 procedures proposed to be added in 2009 – CPT code, a short description and national payment rate. www.ascassociation.org/add09p.pdf
Device Intensive Procedures – This chart lists the procedures proposed to be device intensive in 2009 and the proposed 2009 ASC payment rate. The chart also includes whether or not they are proposed to be device intensive for the first time. www.ascassociation.org/intensive09p.pdf
Ancillary Services – This chart includes the list of proposed covered ancillary services integral to covered surgical procedures for 2009 including ancillary services for which payment is packaged. A short description of the service and the proposed payment rate is also included. www.ascassociation.org/ancillary09p.xls
Office Based Procedures – This chart lists the procedures proposed to be classified as office based in 2009, the proposed 2009 payments and whether the rates are based on the hospital outpatient department weights or on the physician’s practice expense portion. www.ascassociation.org/office09p.pdf
