decisionhealth Newsletters, Part B News - 2007 Issue 7 (July)
Final ASC payment rule eases caps in pay switch
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Article Overview
This article covers CMS’s final rule for ambulatory surgery center (ASC) payments and the shift to an OPPS-like payment system. It is relevant to facility coders, revenue cycle staff, ASC administrators, and specialty practices that perform procedures in ASCs. The article discusses broad categories of payment policy changes, the phase-in of the new system, service inclusion and exclusion criteria, and the impact on procedures commonly performed in outpatient settings.
Why This Topic Matters
The rule affects how ASC services are reimbursed and which procedures remain payable in the ASC setting, making it important for organizations that code, bill, or plan outpatient surgical services.
Article Sections
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Final ASC payment rule and payment transition
Overview of CMS’s final ambulatory surgery center payment rule and the shift to a new payment methodology. Covers the general phase-in approach and timing of implementation.
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Impact on procedures and ASC service eligibility
Discusses the types of procedures newly added to ASC payment coverage and the broad criteria CMS uses when determining whether services are excluded from ASC payment.
What You Will Learn
- How CMS’s final ASC payment rule changes the overall payment framework
- What broad categories of services are affected by the new ASC methodology
- How the rule addresses phase-in timing and service eligibility in ASCs
- Which general factors CMS considers when excluding services from ASC payment
Who Should Read This
- ASC administrators
- medical coders
- billing specialists
- revenue cycle staff
- outpatient surgery practices
- healthcare compliance professionals
Codes Discussed
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