REGULATORY REVIEW: CMS Policies that Impact ASC Payments


CMS Policies that Impact ASC Payments

The ASC weight scalar exacerbates the difference in ASC and HOPD pay rates

In the 2019 final payment rule for ASCs and hospital outpatient departments (HOPD), the Centers for Medicare & Medicaid Services (CMS) finalized its proposal to align the two entities’ update factors and moved ASCs to the hospital market basket, which has long been used to update HOPD payments. CMS plans to use the hospital market basket to update ASC payments for the five-year period of calendar year (CY) 2019 through CY 2023. CMS indicated in its 2019 and 2020 payment rules that it anticipates volume will shift to the ASC setting due to this policy change.

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