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Comment Now on 2023 Medicare Proposed Rule
Make your voice heard
BY KARA NEWBURY | SEPTEMBER 2022
The deadline to submit comments on the Centers for Medicare & Medicaid Services’ (CMS) 2023 proposed payment rule for ASCs and hospital outpatient departments (HOPD) is Tuesday, September 13. ASCA will once again submit comments raising industry-wide concerns, but it is important that CMS hears from individual centers as well.
CMS released the proposed rule on July 15. The agency provides a 60-day comment period to enable stakeholders to provide feedback to its proposed rule. When presented with compelling information, CMS sometimes changes course between proposed and final rules.
Last year, CMS proposed to move total shoulder arthroplasty (CPT 23472), total ankle replacement (CPT 27702) and a lumbar spine fusion code (CPT 22630) back onto the inpatient-only (IPO) list. ASCA and key stakeholders opposed this backward movement, pointing out how these procedures were already performed on non-Medicare populations in ASCs and should be moving in the other direction, to the ASC Covered Procedures List (ASC-CPL). We presented research and data from our facilities and in the final rule, CMS decided not to put those codes on the IPO list, keeping us one step away—instead of two—from getting these codes added to the ASC-CPL.
That is just one example of how comments can help further the ASC community’s advocacy efforts. The submission of formal comments also can kickstart discussions that will continue throughout the year and help ASCs in future rulemaking.
Make your voice heard by submitting comments via regulations.gov by Tuesday, September 13.
Sample Language
Included below is sample language that can be incorporated into your comments. The most persuasive comments also will include individual details regarding how proposals in the rule will impact your center.
Procedure List
The information below provides a comparison between the 2023 ASC and HOPD reimbursement proposals.
General comments: “With technological advances driving procedures from the inpatient to the outpatient setting, we urge CMS to leverage the high-quality and cost-effective care that ASCs provide by allowing physicians to perform the same procedures at ASCs that they are currently allowed to perform at hospital outpatient departments (HOPD). ASCs must meet the same federal regulations to be certified by Medicare, and, like ASCs, it is common for HOPDs to be located off the hospital’s main campus and look like ASCs. There are currently 370 codes that are reimbursable when performed in HOPDs but not in ASCs. If procedures are safe and appropriate in HOPDs that look and operate essentially the same as ASCs, they are safe and appropriate for our facility, and we request that these codes be added to the ASC Covered Procedures List (ASC-CPL).”
Codes your facility believes should be added (add your specific requests): “Our physicians have identified [name the specific procedure(s)] as resulting in positive outcomes when performed on non-Medicare patients in the ASC setting and thus should be added to the ASC Covered Procedures List (ASC-CPL).” More persuasive letters will include clinical data. If there are procedures currently on the ASC-CPL that are clinically similar to the requested codes, that also helps.
Complexity Adjustment Proposal
“We strongly support this proposed policy and commend CMS for providing an opportunity for better access to Medicare beneficiaries and significant cost savings to the Medicare program.
As CMS notes in this proposed rule, while add-on codes (N1) do not come with additional reimbursement (packaged into primary code), 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. For HOPDs, Medicare provides a ‘complexity adjustment,’ adjusting the payment rate for certain primary procedures to account for the cost of also performing certain add-on procedures.
Under the proposal, Medicare will now provide a payment adjustment for add-on procedures performed with primary procedures in an ASC if the combination of procedures receives a ‘complexity adjustment’ in the outpatient setting, making it economically feasible for ASCs to perform these code combinations.”
Quality Reporting Program
ASC-11: Cataracts Measure: “We appreciate CMS’ proposal to suspend implementation of ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery. This measure would be administratively burdensome for our facility, and it is not reflective of the attributes of the ASC facility or the actions of its staff during the patient’s time in the facility.”
Template Letters
ASCA has prepared sample comment letters that ASCA members can customize before submitting to CMS.
The following templates are available:
- Procedure list letter: A template letter requesting that additional codes be added to the ASC-payable list.
- ASC-11 letter: A template letter supporting the suspension of ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery from the ASC Quality Reporting (ASCQR) Program, which was set to be mandatory beginning in 2025.
- Complexity adjustment letter: A template letter supporting an ASC complexity adjustment for combinations of primary service and add-on codes similar to the one currently available to HOPDs.
- ASC weight scalar letter: A template letter requesting that CMS eliminates the ASC weight scalar, a secondary rescaling applied to ASCs that contributes to the growing disparity in reimbursement rates between ASCs and HOPDs.
The most persuasive letters are those that include individual details regarding how the proposed changes will impact your center and specific information such as your center’s case volume and any outcomes data you can share. Copy and paste the comment letter onto your center’s own letterhead. ASCA members also can request help customizing their letter(s). Write Kara Newbury for assistance.
Submit your comments on regulations.gov by Tuesday, September 13.