- Disclose criteria used to determine ASC procedure list. CMS can exclude a procedure from the ASC procedure list because of a general concern for seven specific criteria. The agency, however, is not required to disclose which of the criteria excludes a given procedure. This makes it difficult for ASCs to marshal the data needed to challenge these decisions. This provision will add clarity to the CMS review process by requiring CMS to disclose which criteria trigger a procedure’s exclusion and prohibits CMS from excluding procedures reported with unlisted codes from the ASC setting. Adding procedures that can be performed safely in an ASC to this list saves Medicare and its beneficiaries money.
These provisions will help ASCs, specialty societies and other health care stakeholders engage CMS as it considers changes to the ASC Payment System. Further, H.R. 6138 will support Medicare beneficiaries as they seek the high-quality, efficient and cost-effective community care that ASCs deliver.
ASCA has advocated for these provisions for several years and will continue monitoring the progress of this legislation.
For more information on the ASC Payment Transparency Act and other federal legislative activity, write Jeff Evans.