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Archive December 2018 XIX, No. 12

Reimbursement Update: Medicare Payment Rule a Big Win for ASCs

Breaking down the good news for ambulatory surgical centers.

William Eck

William Eck


LEVEL PLAYING FIELD Medicare will use the same measure to update ASC and HOPD payments, a policy change that could shorten the disparity between what CMS reimburses for the same procedures.

Whether it was skimping on their yearly payment updates or refusing them separate reimbursement for device-intensive procedures, Medicare's annual payment rule routinely snubbed and shortchanged ambulatory surgical centers. Not this year. Surgery centers came out on top like never before in CMS's 2019 final payment rule for hospital outpatient departments (HOPDs) and ASCs, released last month (

And we're not just talking about ASCs receiving a bigger 2019 rate increase (2.1%) than hospitals (1.35%). From aligning the inflation factors it uses to update payments to lowering the threshold for device-intensive procedures, Medicare's payment policy strongly favors ASCs, perhaps a nod to the agency's desire to shift cases from higher-cost HOPDs to lower-cost ASCs.

"The changes included in this year's rule are among the most significant I have seen in my 8 years with ASCA," says William Prentice, CEO of the Ambulatory Surgery Center Association. "Overall, I would say they demonstrate greater recognition of the quality and value ASCs provide than we have seen in any previous rulemaking."

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