2020 Proposed Rule That May Affect Your ASC

2020 Proposed Rule That May Affect Your ASC

The Centers for Medicare & Medicaid Services just released a proposed rule.

Being a full-service healthcare revenue cycle management and consulting firm, it’s our job to be on top of industry updates and new laws — that includes proposed updates and changes.

While you may have seen the Centers for Medicare & Medicaid Services (CMS) Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS-1717-P), we would be remiss not to provide this information on our own blog.

On July 29, the CMS proposed policies that follow directives in President Trump’s Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First

The President’s order calls for a patient-driven healthcare system by making prices for items and services provided by all hospitals in the United States more transparent for patients, allowing them to be more informed about what they might pay for hospital items and services. CMS’s proposal builds on this foundation.

The policies in the CMS 2020 OPPS/ASC Payment System Proposed Rule would further advance CMS’s commitment to:

  • Increase price transparency 
  • Strengthen Medicare 
  • Rethink rural health 
  • Unleash innovation 
  • Reduce provider burden 
  • Strengthen program integrity 

They focus on these commitments so that hospitals and ambulatory surgical centers can operate with better flexibility, giving patients have what they need to become active healthcare consumers. This fact sheet discusses the major provisions of the proposed rule in relation to each of CMS’s core tenants. 

ASCA’s news release provided a high-level overview of how the CY 2020 OPPS/ASC proposal could affect ASCs. Here’s a quick glimpse.

  • CMS proposed to continue to align the ASC update factor with that used to update HOPD payments. Under the proposal, CMS would continue to use the hospital market basket to update ASC payments for calendar year 2020 through 2023 as the Agency assesses this policy’s impact on volume migration.
  • CMS proposed a 2.7% average rate update. If the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.7%. CMS does not consider sequestration in its proposed rule. The statutory 2.0% reduction remains in effect until at least 2024 unless Congress acts.
  • CMS proposed eight additional codes be added to the ASC-payable list.
    • 1.  27447 (Total knee arthroplasty)
    • 2.  29867 (Allgrft implant knee w/scope)
    • 3.  92920 (Prq cardiac angioplasty 1 art)
    • 4.  92921 (Prq cardiac angio addl art)
    • 5.  92928 (Prq card stent w/angio 1 vsl)
    • 6.  92929 (Prq card stent w/angio addl)
    • 7.  C9600 (Perc drug-el cor stent sing)
    • 8.  C9601 (Perc drug-el cor stent bran)
  • For the ASC Quality Reporting (ASCQR) Program, CMS proposes to adopt one claims-based measure and requests comments on potential submission methods for certain patient safety measures in future rule-making.
  • CMS proposed to adopt ASC-19: Facility-Level 7-Day Hospital Visits after General Surgery Procedures Performed at Ambulatory Surgical Centers for 2024 payment determinations and beyond.

Comments on the proposed rules are due by Sept. 27, 2019. The Final Rule will likely be released in early November, and new payment provisions will go into effect on Jan. 1, 2020.

To see CMS’s 2020 OPPS/ASC proposed rule fact sheet — including how each piece of the proposal fits into CMS’s mission and potential future proposals — visit www.cms.gov.

In an ever-evolving industry, it can be overwhelming to stay on top of all the changes and updates. Let us help you! in2itive business solutions can help get your ambulatory surgery center, hospital, or physician practice on track with comprehensive revenue cycle management services, coding audits, and financial consulting.

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