Ep. 14: Kara Newbury – Acting on CMS’ 2023 Final Medicare Rule |This Week in Surgery Centers

Here’s what to expect on this week’s episode. 🎙️

Since the 2023 Final Rule was published this past November, ASCs have rightfully had a lot of questions trying to decipher what Centers for Medicare & Medicaid Services requires this year.

Kara Newbury, the Ambulatory Surgery Center Association’s Director of Government Affairs and Regulatory Counsel, has advocated for ASCs for over ten years, and she’s here with us today to help us decipher the changes as we’re officially in the new year. Here are a few highlights.

💰 Medicare Reimbursement Rate – The effective update is 3.8%. While it’s disappointing it wasn’t higher, as we know ASCs are facing so many increased costs right now, it’s a small win that it was higher than the original 2.7% in the proposed rule.

📝 ASC Covered Procedures List – Every year, ASCA surveys its members to see what procedures they perform in the private pay market that would be safe for Medicare patients. Out of the dozens ASCA submitted, #CMS only added four new procedures in 2023.

✋ Nomination Process – CMS is introducing a new nomination process so that any ASC stakeholder can submit codes that they believe should be payable in the #Medicare space. This process will start on January 1, 2024, which means it will be effective for 2025 rulemaking.

✍️ Complexity Adjustment Policy – This is a huge win for ASCs. Fifty-five code combinations were approved for ASCs, which will increase reimbursement for cases that end up being more complex and have a higher cost.

📊 ASC Quality Reporting Program – While there were a handful of reporting changes, it’s important to know that data for ASC measures 1-4 (burns, falls, wrong events, and hospital transfers) must be collected for all patients and is no longer claims-based. ASCs will then submit data through a web-based portal starting in May.

Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details!