WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest government affairs news from ASCA:

• 2023 OPPS/ASC Final Rule Released

As ASCA alerted members, the 2023 hospital outpatient prospective payment system (OPPS)/ASC final rule was released on November 1. The Centers for Medicare & Medicaid Services (CMS) finalized an effective update of 3.8 percent—a combination of a 4.1 percent inflation update based on the hospital market basket and a productivity reduction of 0.3 percentage points mandated by the Affordable Care Act. This is an increase of 1.1 percent from the proposed rule. Please note that this is an average and updates might vary significantly by code and specialty.

CMS also finalized a policy to provide complexity adjustments for combinations of certain service codes and add-on procedure codes that are eligible for a complexity adjustment under the hospital OPPS. While add-on codes (N1) do not receive additional reimbursement when packaged into primary codes, the addition of the add-on codes to a primary procedure code often changes the complexity of the procedure, making it more costly to perform. As finalized in this rule, Medicare will now provide a “complexity adjustment” to adjust the payment rate for certain primary procedures to account for the cost of also performing certain add-on procedures. There are 55 new C-codes that represent these procedure combinations.

Although ASCA provided a list of dozens of procedures that are performed safely on non-Medicare populations in the ASC setting for consideration to be added to the ASC Covered Procedures List (ASC-CPL), CMS added only four of the requested codes:

·         19307 (Mast mod rad)

·         37193 (Rem endovas vena cava filter)

·         38531 (Open bx/exc inguinofem nodes)

·         43774 (Lap rmvl gastr adj all parts)

With regards to the Ambulatory Surgical Center Quality Reporting (ASCQR) Program, CMS finalized its proposal to suspend the mandatory adoption of ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery in the ASCQR Program. ASCA has been strongly advocating for this measure to remain voluntary.

The final rule rate calculator is already available to members on our Medicare Payment Resources page, and we will continue to add to these resources in the coming weeks.

• ASCA 2023 Fly-In Save the Date

ASCA’s National Advocacy Day returns February 27-March 1, 2023, at the Washington Marriott Capitol Hill. National Advocacy Day gathers engaged members of the ASC community from across the country to advocate for their facilities and the high-quality care they deliver. It is an excellent opportunity to meet face-to-face with your members of Congress and their staff to educate them about the many benefits ASCs provide. CLICK HERE for more information and to register for this important event.