On Nov. 2, CMS received the 2018 final payment rule, providing a 1.2 percent increase in ASC reimbursement next year. The final rule also addressed several issues pertaining to orthopedic procedures in ASCs, including total joint replacements and spine procedures.
Here are five ways the final rule will affect orthopedic ASCs, according to guidance from ASCA:
1. Total knee replacements: CMS removed total knee replacement from the inpatient only list, but did not add it to the ASC payable list. The agency will continue discussion on other joint replacement codes before removing them from the inpatient only list as well. While some in the industry are excited by this move, which could bring total knee replacements a step closer to the ASC payable list, others feel it could have a negative impact on an ASC’s ability to negotiate fair contracts with private payers if CMS sets the rate too low.
2. Total and partial hip replacements: In the proposed final rule, CMS solicited comments for adding total and partial hip replacements to the ASC payable list, but decided not to add them in the final rule, stating, “Our understanding is that these procedures typically require more than 24 hours of active medical care following the procedure.”
3. Spine surgery: CMS added two spine procedures to the ASC payable list, including total disc arthroplasty with discectomy (22856) and second-level cervical disc arthroplasty with discectomy (22858).
4. Quality reporting: A new quality measure was approved that will affect orthopedic surgery centers specifically: ASC-17 will collect data via claims for hospital visits after orthopedic procedures in the ASC. Data collected over the next few years will affect payment determination in 2022 and subsequent years.
5. Payment rates: Overall, ASCs received a 1.2 percent reimbursement increase and hospital outpatient departments received a 1.35 percent increase.
Written by Laura Dyrda, Becker’s ASC Review | November 08, 2017