CMS Final Rule Updates ASC Conversion Factor, Payment Rates

From 2019 through 2023, ambulatory surgical center (ASC) payment rates will be updated using the hospital market basket instead of the consumer price index-urban, according to the calendar year (CY) 2019 Hospital Outpatient Prospective Payment System and ASC Payment System Policy Changes and Payment Rates final rule issued by the Centers for Medicare & Medicaid Services (CMS).

According to CMS, this change should encourage site neutrality between hospitals and ASCs and use of lower cost ASC settings over hospital settings.

In addition, CMS announced that they will adjust the CY 2018 ASC conversion factor ($45.575) by the proposed wage index budget neutrality factor of 1.0004 in addition to the multifactor productivity (MFP)-adjusted hospital market basket update factor of 2.1%. For ASCs meeting the quality reporting requirements, the CY 2019 ASC conversion factor is $46.551.

For ASCs not meeting the quality reporting requirements, CMS will adjust the CY 2018 ASC conversion factor ($45.575) by the proposed wage index budget neutrality factor of 1.0004 in addition to the quality reporting/MFP-adjusted hospital market basket update factor of 0.1%, which results in a CY 2019 ASC conversion factor of $45.639.

It was noted in the final rule that the CMS will retain the ASC-11: Cataracts-Improvement in Patient’s Visual Function within 90 Days, with voluntary reporting.

You can read more here.