CMS-Proposed Rule: Changes to the Ambulatory Surgical Center Payment

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CMS-Proposed Rule Changes to the
AmbulatorySurgical Center Payment
The Center for Medicare and Medicaid Services
(CMS) proposed a new rule that will update the
payment policies and rates. The update will
specifically cater to Hospital Outpatient and
Ambulatory Surgical Centers (ASC). The rules will
set forth a motion to promote efficient service
and promote higher quality service for all the
Medicare beneficiaries. The proposed rule will
replace the current ASC payment system laid out
during 2013 which accounted for around 4.10
billion. The proposed rule for 2018 would
revise the Medicare hospitals outpatient
prospective payment system (OPPS) and the
Ambulatory Surgical Center (ASC). To implement
different changes which have been derived from
different experience the change will include
various factors which will be calculated to
determine the payment rate for Medicare services
paid for ASC. Medicare currently pays more than
4,000 hospitals which include general acute care
hospital, long-term acute, Childrens, cancer,
inpatient psychiatric hospitals. For all the
above hospitals outpatient services were paid
according to the OPPS. Services under the OPPS
are classified into different payment groups-
Ambulatory Payment Classification (APCs).
Services included under the APC are clinically
similar and payment is set for each of the APC.
Each of the payment rates is adjusted according
to the different geographic regions.
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CMS-Proposed Rule Changes to the
AmbulatorySurgical Center Payment
Usually, Medicare beneficiaries share the cost of
service which is laid by CMS. This can be up to
20 percent of coinsurance or certain service. A
copayment under the Medicare law should not
exceed more than 40 percent of the total payment.
CMS has laid down the rules where an overall
beneficiary of the Medicare is now required to
pay be 20 percent through coinsurance.
Currently, there are approx. 5,000 Medicare
participating ASC facilities and since 2008 all
the facilities are paid under the revised rule.
Under the revised rule all hospital outpatient
settings are based on the ASC payment rate
wherein APC out weights for any services. In the
rule, CMS adopted criteria that allowed for more
procedure and service to be covered when the
patient visits an ASC setting. The revised ASC
payment is established to reflect on criteria as
same relative resource is used for the procedure
as under outpatient payment. Considering the
lower cost of the surgical procedure at ASC the
new revised rule was to maintain the budget
neutrality in the payment system. Changes in
ASC payment rate CMS is proposing the increase of
ASC payment rate by 1.3 percent or by consumer
price index for urban areas to 2.2 percent minus
the multifactor productivity adjustment by 0.9
percent. CMS also has stated that they believe
that the payment rate will be stable at 57
percent for the proposed service.
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CMS-Proposed Rule Changes to the
AmbulatorySurgical Center Payment
Proposed revision for the payment under new
technology intraocular lenses CMS has also
proposed significant revisions to the regulations
for the new technology intraocular lens. The CMS
is also proposing the FDA's approval in labeling
the claim for a specific clinical benefit based
on the new characteristics of the lens. ASC
quality measure reporting CMS has concluded to
measure the facilities on eight quality measures
which are to be reported under the ASC quality
reporting. Five of those would apply to the
encounters at the beginning. CMS is also
proposing the requirement to include procedural
quality data reporting for updating different
measures and data completion requirement. This
also includes 2 percent payment reduction when
the requirements are not met. Medical Billers
and Coders with a 19 year experience in ASC
coding and billing is working on the proposed
rules to understand different affecting areas of
your revenue generation. This would not include
the detail analysis based on your facility but
understanding the patient care requirements.
Medical Billers and Coders will provide you with
detailed analysis of your revenue generation
including the lose areas of revenue leak.