in2itive is kicking off the New Year with big plans to support and advocate for the needs of ambulatory surgery centers (ASCs) on Capitol Hill. The Ambulatory Surgery Center Association’s (ASCA) 2024 National Advocacy Day, set for February 26-28, presents a crucial opportunity for direct engagement with policymakers who influence ASC-related healthcare decisions. During these congressional meetings, ASC representatives will highlight the immense value and potential of surgery centers in raising care standards and controlling costs. As a sponsor of National Advocacy Day, alongside industry leaders like MedTrainer, in2itive is eager to contribute to positive developments for ASCs, payers, and patients nationwide.
On the Agenda: Exploring New ASC Legislation
A core theme of National Advocacy Day is bringing awareness to the continually changing ASC landscape of reimbursements and compliance. The Outpatient Surgery Quality and Access Act of 2023 (H.R. 972/S 3.12) introduces crucial legislation concerning Medicare payments to ASCs. With projections indicating ASCs will save Medicare $73 billion from 2019 to 2028, new policies aim to broaden access to high-quality, cost-effective care.1
Here are six significant changes in the new legislation:
- Permanent Reimbursement Update Factors. ASC reimbursement update factors are now set in stone and fully aligned with hospital outpatient department (HOPD) factors, closing the gaps in cost disparities for identical surgical procedures.
- Quality Information for Beneficiaries. The US Department of Health & Human Services (HHS) is now required to provide easy-to-read price comparisons to help Medicaid beneficiaries and the general public evaluate procedural cost differences between ASCs and HOPDs.
- Greater ASC Representation in Payment Decisions. The ASC community can now designate a representative to sit on the Advisory Panel on Hospital Outpatient Payment, a previous hospital- and health system-only board, to advocate for ASC-friendly financial structures.
- Transparency in the ASC-CPL. The Centers for Medicare and Medicaid Services (CMS) is now required to provide its rationale for accepting or refusing to add requested codes to the ASC Covered Procedures List (ASC-CPL).
- Elimination of the Copay Penalty. Medicare beneficiaries, especially those without supplemental coverage, now receive the same (lower) copay cap in ASCs as those who seek care in HOPDs, helping increase ASC case volume and reimbursement.
- Natural Growth of ASC Utilization. CMS can no longer apply a secondary ASC scaling calculation for budget neutrality. This policy establishes comparable payment weights between ASCs and HOPDs by removing penalties for shifting Medicare services to lower-cost settings.
The 2023 ASCA Advocacy Day efforts paid off big! We are excited that the in2itive team was able to take part in last year’s event that played a role in finalizing these legislative changes. We’re grateful for the opportunity to once again participate in initiatives to give more ASCs a seat at the table — and more reimbursements in the pipeline.
Leveraging New Billing Opportunities in 2024
These legislative updates are a success for the ASC community. We’re excited to be part of promoting the value of ASCs and pleased that legislators are recognizing the high-quality care provided by surgery centers. Nonetheless, implementing these changes can be challenging, particularly for busy billing teams.
Feeling overwhelmed by these new policies? If navigating these billing changes seems daunting, consider partnering with a trusted expert like In2itive. Our skilled ASC revenue cycle management (RCM) team can simplify this transition, enabling your facility to quickly embrace these new revenue opportunities and optimize reimbursements.
Sources
- Study: Reducing Medicare Costs by Migrating Volume from HOPDs to ASCs. (October 2020). Advancing Surgical Care. https://www.ascassociation.org/asca/about-ascs/savings/medicare-cost-savings/reducing-medicare-costs
