On November 2nd, the Centers for Medicare and Medicaid Services released the CY 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule. Key provisions of the proposal include the following:
Changes to the ASC Covered Procedures List
For CY 2022, CMS is reinstating the criteria for adding procedures to the ASC CPL that were in place in CY 2020. In the CY 2022 OPPS/ASC proposed rule, CMS requested comment on whether any of the 258 procedures proposed for removal from the ASC CPL met the proposed reinstated criteria. CMS received 140 procedure recommendations, including new procedures and procedures that were already on the CPL and not proposed for removal. Based upon review of these procedure recommendations, CMS is keeping six procedures, three that were already on the ASC CPL and three that were proposed for removal, and removing of 255 of the 258 procedures proposed for removal. The three codes that were proposed for removal and are being retained are CPT codes 0499T, 54650, and 60512.
CMS is also finalizing the adoption of a nomination process, which will begin in March 2022, to allow an external party to nominate a surgical procedure to be added to the ASC CPL. If CMS determines that a surgical procedure meets the requirements to be added to the ASC CPL, including a surgical procedure nominated by an external party, it would propose to add the surgical procedure to the ASC CPL for January 1, 2023.
Changes to the Inpatient Only List
CMS is finalizing its proposal to halt the elimination of the IPO list and add back to the IPO list the services removed in 2021, except for CPT codes 22630 (Lumbar spine fusion), 23472 (Reconstruct shoulder joint), 27702 (Reconstruct ankle joint) and their corresponding anesthesia codes. This change in policy promotes transparency and ensures that any service removed from the IPO list has been reviewed against Medicare’s longstanding IPO list criteria to determine if it is appropriate for Medicare to pay for the provision of the service in the outpatient setting.
Updates to OPPS and ASC payment rates
CMS is updating the CY 2022 OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.0 percent. This update is based on the projected hospital market basket increase of 2.7 percent reduced by 0.7 percentage point for the productivity adjustment.
Use of CY 2019 Claims Data for CY 2022 OPPS and ASC Payment System Ratesetting Due to the PHE
Ambulatory Surgical Center Quality Reporting (ASCQR) Program
CMS is finalizing proposals to (1) adopt one new measure, the COVID-19 Vaccination of Health Care Personnel (NQF #0431) and (2) to make the reporting of six voluntary or suspended measures mandatory.
Hospital Price Transparency increase penalties for noncompliance
Our clients are typically bold, ambitious leaders within the surgery market. They share our passion for results and are prepared to act decisively to achieve them.
Read below to see what our clients think about us and our performance. And we highly encourage you to speak with them so that you can hear it first hand.
“They are us and we are them. National's approach since being with us has been as a partner or better yet a family who cares about our success and does everything in its power to assist us in being successful."
DIRECTOR OF NURSING | LOS ALAMITOS, CALIFORNIA
OUR CLIENTS SAY IT BEST
Our clients are typically bold, ambitious leaders within the surgery market. They share our passion for results and are prepared to act decisively to achieve them.
Read below to see what our clients think about us and our performance. And we highly encourage you to speak with them so that you can hear it first hand.
"National Medical’s coding audit identified that our previous billing partner was coding and billing our ASC claims improperly. We were actually losing money on some cases because costly implant charges were not being coded and billed correctly. National Medical was able to go back and capture significant lost revenue. Their specialized, ASC expert coders have maximized our revenue and compliance."
MEDICAL DIRECTOR | CLEVELAND, OHIO
OUR CLIENTS SAY IT BEST
Our clients are typically bold, ambitious leaders within the surgery market. They share our passion for results and are prepared to act decisively to achieve them.
Read below to see what our clients think about us and our performance. And we highly encourage you to speak with them so that you can hear it first hand.
“I can already tell the difference in the quality of work compared to our previous billing company. The responses and willingness to help us be successful shows in how fast we receive a response, resolution and the wealth of knowledge you share with us. Thank you!”
ASC ADMINISTRATOR | FREMONT, CA
OUR CLIENTS SAY IT BEST
Our clients are typically bold, ambitious leaders within the surgery market. They share our passion for results and are prepared to act decisively to achieve them.
Read below to see what our clients think about us and our performance. And we highly encourage you to speak with them so that you can hear it first hand.
"National Medical’s expertise in the ASC market revealed that our contracts were reimbursing less than Medicare and in some cases only 38% of Medicare. Due to their expertise and experience, they were able to renegotiate better contracts and increase our contract reimbursement by 305%. We’re now able to bring additional cases to our center."
ASC ADMINISTRATOR | BALTIMORE, MARYLAND
OUR CLIENTS SAY IT BEST
Our clients are typically bold, ambitious leaders within the surgery market. They share our passion for results and are prepared to act decisively to achieve them.
Read below to see what our clients think about us and our performance. And we highly encourage you to speak with them so that you can hear it first hand.
"Before we hired National Medical, we were handing billing in house and were averaging $811 for each surgery. In our very first year with National Medical, with the same number of cases, we have increased our cash per case to $1,400. That represents an increase of approximately $600 per case, or 73 percent, all of which is pure profit for us. In absolute terms, that means an additional $90,000 per month to us on the same number of cases."
OWNER AND CEO, SURGERY CENTER | BAKERSFIELD, CALIFORNIA
OUR CLIENTS SAY IT BEST
Our clients are typically bold, ambitious leaders within the surgery market. They share our passion for results and are prepared to act decisively to achieve them.
Read below to see what our clients think about us and our performance. And we highly encourage you to speak with them so that you can hear it first hand.
“We have not second guessed our decision to switch billing companies once since transitioning to National Medical. Their team seems to remind us constantly why it was such a good decision!
ASC ADMINISTRATOR | SOUTHLAKE, TX
OUR CLIENTS SAY IT BEST
Our clients are typically bold, ambitious leaders within the surgery market. They share our passion for results and are prepared to act decisively to achieve them.
Read below to see what our clients think about us and our performance. And we highly encourage you to speak with them so that you can hear it first hand.
"National Medical consistently exceeds our expectations by going above and beyond every day. Their team is proactive, highly attentive and smart. To top it off, their detailed analytics team provides us with powerful insights into our business, allowing us to make informed decisions. In short, they are the perfect partner for all of our revenue cycle needs."
CHIEF OPERATING OFFICER, SURGERY CENTER | PORTLAND, OREGON
