ASCA Resources and Analysis: Medicare’s 2019 Final ASC Payment Rule

November 14, 2018

ASCA has conducted a more in-depth review of Medicare’s 2019 ASC Payment System final rule and produced a resource that analyzes the rule’s main provisions. This table (available to ASCA members only) summarizes select proposals from the 2019 proposed rule, ASCA’s comments in response to those proposals and the subsequent determinations made in the final rule.

ASCA members can also use this table to review reimbursement rates for codes that have historically had high volume in the ASC setting. The document provides a comparison between 2018 and 2019 final rates, as well as 2019 proposed and 2019 final rates.

In addition, ASCA’s Rate Calculator (available to ASCA members only) has been updated to reflect the changes finalized in the 2019 ASC final payment rule. As a reminder, for codes not subject to geographic wage index adjustments such as drugs, biologicals, devices with OPPS transitional pass-through payment status and brachytherapy sources, the Rate Calculator will only display a national payment rate because that is the payment rate regardless of where you are in the country. 

Please note that ASCA has reached out to CMS staff to alert them to potential errors in the payment resources the agency released, particularly the extremely high number of codes marked as being exempt from multiple-procedure discounting. As such, ASCA took that column out of the rate calculator for now. ASCA does expect a correction notice to be forthcoming from the agency and will update members once that information becomes available. 

To learn more about the final rule and its impact on your facility, register for ASCA’s next webinar, Understanding Medicare’s 2019 Final Payment Rule, taking place on Tuesday, December 4, at 1:00 pm ET.