2016-07-07 15:54:09 UTC

ASC and Hospital Outpatient Rules Released

July 7, 2016

CMS recommended changes to the amounts and factors used to determine the payment rates for Medicare services.

Late yesterday, CMS released the 2017 proposed rule that includes policy and payment changes for the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Centers (ASC). AGA, which sent out a member alert yesterday along with ACG and ASGE, is currently reviewing the details of the proposed rule and will provide a more extensive summary soon. 

In this proposed rule (which will appear in the July 14 Federal Register and can be downloaded here) CMS describes the recommended changes to the amounts and factors used to determine the payment rates for Medicare services paid under the Hospital Outpatient Prospective Payment System. Here's a quick summary of those recommendations:

ASC Conversion Factor — Using the Consumer Price Index for all urban consumers (CPI-U), CMS proposes two conversion factors: one for ASCs meeting quality reporting requirements of 1.2 percent and one for ASCs not meeting quality reporting requirements of -0.8 percent in calendar year (CY) 2017.

Ambulatory Payment Classification (APC) Adjustments — CMS is proposing some additional modifications in APCs following its reorganization of all APCs that resulted in the restructuring and consolidation of the APCs that contain GI procedures in 2016. We are currently reviewing the list of services and proposed payment rates for 2017 and will post them soon.

CMS will accept comments on the proposed rule until Sept. 6, 2016, and will respond to comments in a final rule to be issued on or around Nov. 1, 2016. We will keep you updated as we learn more. 

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Tri-Society Regulatory Summary for Members of AGA, ACG and ASGE