The Medicare Beneficiary Copay Fairness Act is gaining momentum. Rep. Marc Veasey (D-Texas) has joined as one of the newest cosponsors of the Act. The bipartisan bill was introduced on April 24 and addresses a Medicare payment rule for ambulatory surgery centers (ASCs), where Medicare Part B beneficiaries pay a standard 20% coinsurance for procedures at both ASCs and hospital outpatient departments (HOPDs). However, only HOPD copays are limited by the inpatient deductible, which is … [Read more...]
ASC Delay Marks Yet Another Misfire in CMS’ Prior-Auth Track Record
The U.S. Centers for Medicare & Medicaid Services (CMS) is delaying the implementation of its five-year prior-authorization demonstration for ambulatory surgery centers (ASCs). Originally, the prior-auth demo was set to go live in December 2025 across all participating states: California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia and New York. Now, the demo will be rolled out in two phases. ASCs in California, Florida, Tennessee, Pennsylvania, Maryland, … [Read more...]
‘Be Comfortable with Being Adaptable’: ASC Leaders React to 2026 Payment Rule
In what can be seen as a victory for ambulatory surgery centers (ASCs), the U.S. Centers for Medicare & Medicaid Services (CMS) on Nov. 21 finalized its proposal to phase out Medicare’s inpatient-only list and open the door for which procedures can be covered in the ASC. In addition to those moves, ASCs will see an average update of 2.6%, which includes a 3.3% inflation adjustment and a 0.7 percentage-point productivity adjustment. The ASC community has been advocating for years to … [Read more...]
[Updated] Citing Need to Stop Services from ‘Unnecessarily Being Performed in Hospitals,’ CMS Finalizes Expansion of ASC-Covered Procedures
The U.S. Centers for Medicare & Medicaid Services (CMS) on Nov. 21 moved forward with its plans to substantially expand the list of procedures outpatient surgery centers are allowed to perform. The agency also solidified its proposal to phase out Medicare’s inpatient-only list. Broadly, ambulatory surgery center (ASC) leaders have supported CMS’ July 2025 proposal to shift more surgical procedures away from the traditional hospital setting. While such a shift has been happening over the … [Read more...]
Medicare Finalizes 2026 Physician Payment Rule, New Ambulatory Specialty Model: Top Takeaways for ASCs
The Centers for Medicare & Medicaid Services (CMS) has released the 2026 Medicare Physician Fee Schedule (PFS) final rule, which, as always, has a few key takeaways for ambulatory surgery centers (ASCs). The agency says the rule is focused on modernizing payment accuracy by finalizing an “efficiency adjustment” for select services and a one-time 2.5% increase in physician payments. “CMS is working to strengthen and transform Medicare for current and future generations while cracking … [Read more...]
Ambulatory Surgery Centers Turn to International Talent Amid Staffing Shortages Despite Increasing Visa Costs, Complex Regulations
As nursing and physician shortages continue, ambulatory surgery centers (ASCs) are seeking to recruit talent from other countries to fill the gaps. However, new regulations and government red tape are making it harder to hire that talent. “If any employer thinks they could succeed or keep any system with 100% domestic workers, they are not in touch with reality,” Ann-Rose Johnson-Lewis, director of legal services at WorldWide HealthStaff Solutions, told ASC News. ASCs frequently use … [Read more...]
CMS Clarifies Survey, Certification Procedures During Government Shutdown
The U.S. Centers for Medicare & Medicaid Services (CMS) has clarified its position on survey and credentialing activities during the government shutdown. In a Tuesday memo, the agency effectively limited survey work during the federal shutdown to essential health and safety functions. For ambulatory surgery centers (ASCs), only complaint investigations classified as immediate jeopardy (IJ)and those involving actual harm may proceed, along with revisits approved by exception and … [Read more...]
CMS WISeR Model Brings New Oversight, Raises Questions for ASCs
When the U.S. Centers for Medicare & Medicaid Services (CMS) announced its new Wasteful and Inappropriate Service Reduction (WISeR) Model this summer, the agency framed the program as an effort to cut down on unnecessary spending, fraud and abuse in Medicare. But for ambulatory surgery centers (ASCs), the six-year test could mean new layers of prior authorization, administrative work and uncertainty around how advanced technologies will be applied in clinical decisions. The voluntary … [Read more...]
Inpatient-Only List Overhaul Could Put Pressure on ASC, Post-Acute Care Coordination
A proposal from the Centers for Medicare & Medicaid Services (CMS) to phase out Medicare’s Inpatient-Only List (IPO) while adding more procedures for ambulatory surgery centers (ASCs) is stirring debate over how patients move through the continuum of care. As surgical capabilities advance, more complex procedures can safely take place outside of hospitals, including in ASCs. In turn, CMS in its 2026 proposed payment rule for ASCs has suggested phasing out the IPO list over three years, … [Read more...]
Government Shutdown Brings New Uncertainty for Surgery Centers
The federal government officially shut down on Oct. 1 after Congress failed to reach agreement on a short-term spending bill. The immediate fallout will mean furloughs for hundreds of thousands of federal workers and stalled services across multiple agencies. For ambulatory surgery centers (ASCs), the impact may not be as direct as it is for hospitals or other federally funded programs, but industry leaders say ripple effects could be on the horizon if Congress does not act soon. “If … [Read more...]