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ASC NEWS |
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ASC Association Government Affairs Report - May 3, 2012 |
Medicare Reduces Lithotripsy Payment Rate
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Due to an error, the Medicare payment rate for CPT 50590 (fragmenting of kidney stone) released in November 2011 was incorrect. The Centers for Medicare & Medicaid Services (CMS) announced that retroactive to January 1, 2012, all claims for this procedure will be paid at the corrected rate, resulting in a 20% reduction in payment for the procedure.
However, ASCA staff has reached out to CMS and has learned that Medicare contractors are not expected to automatically reprocess previously paid claims. If your contractor does, please contact Jonathan Beal at jbeal@ascassociation.org and let him know.
Click here for more information.
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Results from ASCA’s Drug Shortages Survey
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ASCA would like to thank everyone who participated in our recent drug shortages survey.
The survey results found that of the more than 240 respondents, almost 90% are experiencing a drug shortage at least weekly. In addition, more than 80% of respondents were never given advanced notice of the drug shortage.
Early reporting of drug shortages is one of the best ways to help alleviate the problem. If you are experiencing a drug shortage, it is very important that you email the US Food and Drug Administration (FDA) or contact Jack Coleman at jcoleman@ascassociation.org.
The survey results also found that half of respondents had to use an alternative level of sedation and/or alternative medications because of a drug shortage, which many respondents stated led to an increase in patient nausea and vomiting.
In addition, over 10% of facilities responding have had to reschedule a procedure due to a drug shortage.
For more information, contact Jack Coleman at jcoleman@ascassociation.org.
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CMS Releases Quality Reporting Manual |
CMS Releases Quality Reporting Manual
The Centers for Medicare & Medicaid Services (CMS) released its manual for the ASC quality reporting program today (download the manual below). The manual provides detailed information on how ASCs should report information to CMS.
Of note, the manual indicates that ASCs that used a safe surgery checklist based on accepted standards of practice at any time during 2012 can answer “yes” when they report whether they used a safe surgery checklist during the year. Previously, CMS had indicated that ASCs would be able to answer "yes" only if they had a safe surgery checklist in place on January 1, 2012. This change will allow more ASCs to be able to report that they used a checklist in 2012.
Supporting Documents: ASC Quality Reporting Program Manual
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ASC Association Government Affairs Report - April 26, 2012 |
CMS Releases Proposed Quality Reporting Requirements
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The Centers for Medicare & Medicaid Services (CMS) has released proposed guidelines for Medicare’s new ASC quality reporting program (now available on ASCA Connect). The proposal provides information about how the program will work, including compliance measures, deadlines and more. Click here to read ASCA’s initial analysis.
ASCA will submit comments on the proposal and continue to work with CMS as implementation of the new ASC quality reporting program continues. Click here to learn more about the quality reporting program. Also, make certain you are registered for ASCA’s annual meeting in Dallas, Texas, May 9–12. Several sessions at that meeting, including one being presented by CMS quality reporting expert Anita Bhatia, will provide up-to-the minute information and advice about complying with the new program requirements.
For more information, contact Jonathan Beal at jbeal@ascassociation.org.
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ASC Medicare Rates Corrected—Again
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For the second time this month, CMS has made a slight revision to Medicare’s ASC payment rates due to technical errors regarding the rates reported originally. The corrected rates are retroactive to January 1, 2012, but Medicare contractors will not automatically reprocess previously paid claims. They will reprocess claims only upon request for re-adjudication. ASCA’s Rate Calculator, which is available only to ASCA members who log in to ASCA’s web site, has been updated to reflect this correction.
For more information, contact Jonathan Beal at jbeal@ascassociation.org.
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New Cosponsors for ASC Quality and Access Act of 2011
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US Senator Dean Heller (R-NV) and US Representatives Peter King (R-NY), Chris Murphy (D-CT) and Francisco “Quico” Canseco (R-TX) have joined the ASC Quality and Access Act of 2011 as cosponsors.
Rep. Canseco cosponsored the legislation shortly after meeting with the Texas ASC delegation during the April Capitol Hill Fly-ins. Rep. King is chair of the House Homeland Security Committee. He became a cosponsor after his constituent Robert Nelson of Island Eye Surgicenter, LLC, educated him on the industry and made a grassroots appeal for him to cosponsor the legislation—proof that, sometimes, all you have to do is ask.
The ASC Quality and Access Act of 2011 has 45 sponsors and cosponsors in the US House. There are six sponsors and cosponsors in the US Senate.
Visit ASCA’s ASC Quality and Access Act of 2011 page for more information on the legislation and a list of cosponsors.
For more information, contact Brendan Davis at bdavis@ascassociation.org.
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Advocacy in Action
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April marked another strong month of member advocacy efforts, including the Capitol Fly-In Program and member involvement at the state level. From coast to coast, ASCs welcomed legislators to their centers to educate them about the benefits that ASCs provide to patients and the health care system.
US Congressman Mike Thompson visited Specialty Care & Surgery Center in Kelseyville, CA. Dr. Paula Dhanda conducted the tour and relayed that Congressman Thompson seemed very receptive to what he heard.
US Congressman Joe Pitts visited Berks Center for Digestive Health in Reading, PA. Administrator John Gleason conducted the tour and voiced his opinions about the Patient Protection and Affordable Care Act (PPACA), the Removing Barriers to Colorectal Cancer Screening Act of 2012 (H.R. 4120) and the ASC Quality and Access Act of 2011 (H.R. 2108).
Member involvement has been critically important to ASCA’s advocacy efforts, with more than 85% of the cosponsors for the ASC Quality and Access Act of 2011 signing on as a result of member outreach. The Capitol Fly-In Program will be occurring again June 19-20, 2012. Members from Ohio, Oklahoma, California, Nevada, Massachusetts and Arizona are already scheduled to meet with their legislators in Washington, DC, and advocate on behalf of ASCs.
If a legislator visited your ASC this year, you would like to participate in the Capitol Fly-In Program or you want more information about hosting a congressional tour, please contact Morgan Hanson at mhanson@ascassociation.org.
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Senator Ron Wyden to Be Honored by Oregon State Society
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Senator Ron Wyden (D-OR) will be honored with the inaugural American Eagle Award for Distinguished Leadership by the Oregon Ambulatory Surgery Center Association (OASCA) at its annual meeting.
Senator Wyden, the lead Democratic sponsor of the ASC Quality and Access Act of 2011 (S. 1173), has been a longtime supporter of ASCs and the high-quality care that they provide.
In announcing the award, OASCA President Kecia Rardin stated, “I am truly excited and honored that Senator Ron Wyden has accepted our invitation to be our keynote speaker at our annual education conference on November 8th. He will also be presented with the American Eagle Award for Distinguished Leadership by Richard Edelson, MD, who is vice chair of OASCAPAC. I want to acknowledge Dr. Edelson and our Executive Director Rob Schwartz for building a strong relationship with the Senator and his staff.”
The ASC Quality and Access Act of 2011 (S. 1173/H.R. 2108) currently has six cosponsors in the Senate and 45 cosponsors in the House. To contact your members of Congress to request that they support the legislation, please click here.
For more information, please contact Steve Miller at smiller@ascassociation.org.
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ASC Association Government Affairs Report - April 5, 2012 |
Senate Letter to CMS Requests Data on ASC Conversions
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This week, 13 US Senators sent a letter to the Centers for Medicare & Medicaid Services (CMS) seeking data on the recent trend of ASCs being purchased and converted to hospital outpatient departments (HOPDs). Click here to read the letter.
The letter was addressed to Marilyn Tavenner, the Acting Administrator of CMS, and sought specific data on the costs to the Medicare system for 65 conversions that have happened since January 1, 2009. The effort to circulate the letter was led by Sen. Mike Crapo (R-ID) and Sen. Ron Wyden (D-OR), the sponsors of S. 1173, the ASC Quality and Access Act of 2011. The conversion data provided to CMS is based on research conducted by ASCA staff.
In the letter, the Senators point out that the inappropriate use of the Consumer Price Index – All Urban Consumers (CPI-U) to update ASC payments has led to a growing disparity in reimbursements between ASCs and HOPDs for similar procedures. The gap between the reimbursements for the two sites has grown from 86% in 2003 to 58% this year, and the letter makes clear that this disparity in payments may be driving the recent conversion trend.
In addition to Senators Wyden and Crapo, the letter was signed by the following Senators: Lamar Alexander (R-TN), Richard Burr (R-NC), Tom Coburn (R-OK), Bob Corker (R-TN), John Cornyn (R-TX), Chuck Grassley (R-IA), Ron Johnson (R-WI), Mary Landrieu (D-LA), Bill Nelson (D-FL), James Risch (R-ID) and David Vitter (R-LA).
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House Letter Seeks Change in Single Use Vial Policy
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A letter signed by 16 Republican House members is seeking modification of a CMS guideline prohibiting multiple uses of vials labeled for single use. The letter was drafted and circulated by Rep. Ed Whitfield (R-KY), a member of the House Energy and Commerce Subcommittee on Health.
In the letter, the House members argue that the policy is misguided and is causing increased costs to the Medicare system without improving the quality of patient care. The letter points out that “there is no data available to suggest that implementation of one vial per patient will improve quality or care or reduce patient harm. Further it may reduce access to many services.” Click here to read the letter.
The members of the House who signed the letter are: Dan Benishek, MD (R-MI), Brian Bilbray (R-CA), Marsha Blackburn (R-TN), Michael Burgess, MD (R-TX), Bill Cassidy, MD (R-LA), Geoff Davis (R-KY), Brett Guthrie (R-KY), Andy Harris, MD (R-MD), Billy Long (R-MO), Cathy McMorris Rodgers (R-WA), Devin Nunes (R-CA), Ron Paul, MD (R-TX), Phil Roe (R-TN), Mike Rogers (R-MI) and David Schweikert (R-AZ).
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Same Day Surgery Clarification
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CMS has issued a letter to its state survey agency directors clarifying that ASCs can provide required notifications to all of their patients on the day of surgery, without exception, as long as the information is provided before the surgery begins.
ASCA had long advocated for this regulatory revision. The clear restatement of the revised rule contained in the letter gives ASCs the support they need to be able to provide timely, patient-focused service to all of their patients and same-day treatment to patients in need.
Although this change became effective on December 23, 2011, CMS did not send an official notification to its state survey agencies at that time. Since the state agencies are responsible for enforcing the standards, some ASCs undergoing Medicare inspections since December 23 have encountered surveyors who were erroneously applying the previous requirement—that ASCs needed to provide this information at least one day before the date of surgery. ASCA worked to ameliorate these situations by providing ASCs with copies of the new regulatory text.
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Wisconsin Governor Signs ASC Legislation
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Governor Scott Walker signed an amended version of SB 297 on Monday, legislation originally drafted to eliminate the current assessment on ASCs in Wisconsin. The amended version was signed at a ceremony attended by industry leaders from the Association of Wisconsin Surgery Centers, Inc (WISCA).
Under current law, the state Department of Revenue (DOR) may impose an assessment on ASCs, and the state Department of Health Services (DHS) allocates any assessment among the ASCs in proportion to their gross patient revenue. The DOR must transfer 99.5 percent of all monies received from an assessment to the Medical Assistance (MA) trust fund, which finances a portion of the state’s Medical Assistance, or Wisconsin’s Medicaid program.
Amended language was necessary due to state budget constraints, and WISCA worked closely with the state legislature on a compromise. The revised legislation maintains the assessment, but provides that if at any time the federal government does not pay the federal share under the Medicaid program for any payment made with ASC assessment revenue, the DHS must refund those payments to the ASC. The amended language that was enacted mirrors how the hospital assessment is treated in the state.
Before making its way to the governor’s desk, the amended version of SB 297 passed both the Senate and Assembly with strong bipartisan support.
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ASCA Urges ASC Participation in CDC’s Annual ASC Survey
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The survey will collect information on the surgeries performed in ASCs and HOPDs in order to publish reports on outpatient surgery in the United States. These reports will be an important source of information for researchers and policy makers as they will show how many patients ASCs are serving each year.
No identifiable information for either ASCs or patients will be displayed and responses will be kept strictly confidential. Only ASCs that are asked to participate will be allowed to submit data.
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Drug Shortage Resources
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Many ASCs have been experiencing shortages of drugs, such as Fentanyl and Versed. While ASCA is working with other affected groups to find a long-term solution to this vexing problem, there are resources currently available where ASCs can help raise awareness of the shortages. The US Food and Drug Administration (FDA) is responsible for tracking shortages and is working with drug manufacturers to respond to the shortages. The FDA needs to be made aware of these shortages, which is where your help is requested. If your ASC is experiencing a problem obtaining necessary drugs, please report the problem to the FDA. You can file a report to the FDA here.
In addition, the American Society of Health-System Pharmacists (ASHP) is tracking which drugs are in short supply, timelines for delivery of drugs and alternatives that can be used in place of hard-to-obtain drugs. You can find this information by clicking here.
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New Workers' Compensation Reimbursement Manual Announced |
December 6, 2011
The Florida Division of Workers’ Compensation has filed the 2011 Workers’ Compensation Reimbursement Manual for Ambulatory Surgery Centers as final. The effective date of the Manual has been set retroactively at November 13, 2011.
The 2011 Manual does not contain any changes to the MRA schedule or reimbursement formulas. The Manual is significantly re-written and re-organized. FSASC encourages every member to review the Manual and to discuss the changes with their carrier representatives. Note that this 2011 Manual will require the use of the 2010 CPT coding Manual.
Features of the new Manual include:
- Significant reorganization of the contents;
- Transition to an electronic update log system;
- Updates to 2010 CPT and HCPCS;
- Numerous changes and expansions to Manual language.
Please contact us with any questions about the Manual at 850/222-3000 or peter@ascmember.org.
Supporting Documents: Florida ASC 2011 Work Comp Reimbursement Manual
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Medicare Permits Same-Day Surgery Without Exception |
On October 18th, the Centers for Medicare & Medicaid Services (CMS) released a final rule that removes its limitation on ASCs performing procedures on the day they are scheduled. ASCs will now be allowed to provide patient notifications on the day the procedure is performed, clearing the way for same-day surgeries.
The rule:
- Removes the requirement that the notice of patient rights must be provided "in advance of the date of the procedure" and replaces it with the requirement that the notice must be provided "prior to the start of the surgical procedure." This will allow ASCs to determine when they will provide these notices for all their patients as long as they are done prior to the surgical procedure being done. Particularly amends 416.50(a)(1) and other conditions.
- Removes the language of the previous exemption on this subject that provided for "emergency" notices being given on the day of surgery and outlining certain requirements that have to be met for the patient to qualify under the emergency criteria. Amends 416.50(h).
- Revises 416.50(d)(6) to add the patient's representative or the patient's surrogate to the parities that may be given written notice of a grievance decision.
This revision will take effect on December 23, 2011.
To download the complete rule change, click below.
Supporting Documents: CMS Same Day Rule PDF
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Medicaid Updates Florida Rates |
August 29, 2011
The Agency for Healthcare Administration (AHCA) has announced that effective immediately, it has updated the Medicaid reimbursement rates for ASCs. The new rates reflect a transition to Medicare APC pricing while retaining the Medicaid grouper system. The methodology consists in matching the current Medicare reimbursement for each CPT to its closest Medicaid grouper. In certain cases, new groupers were added when the existing Medicaid grouper system did not have a payment that was reflective of Medicare APC pricing.
A number of new procedures are now approved for Medicaid beneficiaries and several obsolete procedures have been removed and are now reimbursed under a more current CPT code. FSASC members should study the attached file to understand all of the changes.
AHCA is also revising the ASC Medicaid Handbook. They hope to hold a rule development workshop in September to hear public comments on the changes they are proposing to the Handbook. No date has been set as yet.
We will keep you posted on these important changes. Please contact us at 850/222-3000 with any questions.
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Updated Version of CMS Guidance for Surveyors: ASCs Released |
Updated Version of CMS Guidance for Surveyors: ASCs Released
CMS has published a new version of the State Operations Manual Appendix L – Guidance for Surveyors: Ambulatory Surgical Centers, which was updated May 13, 2011.
The changes are based on the Survey and Certification Memo issued December 17, 2010, titled “Clarifications to the ASC Interpretive Guidelines – Comprehensive Medical History & Physical (H&P) Assessment.” Among other revisions, a comprehensive H&P and surgery may now be performed on the same day.
Please review the changes in the interpretive guidelines for 416.42(a)(1) (pages 59-60) and 416.52(a)(1) and (2) (pages 157, 158 and 160).
For your reference, the document is being provided with page numbers included.
Supporting Documents: State Operations Manual - Appendix L ASCs 5-13-11
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CMS Issues Clarification on Same Day H&P Assessment |
CMS has released a memo clarifying the use of same day H&P assessments. Below is a summary of the memo.
· Comprehensive H&P and Surgery may be performed on same day: As long as the H&P is performed by qualified personnel, is comprehensive, and is placed in the patient’s ASC medical record prior to surgery, it may be performed on the same day as the surgical procedure, including in the ASC.
· Comprehensive H&P and some elements of the pre-surgical assessments may be conducted as one assessment: If the H&P is conducted in the ASC on the same day as the surgical procedure, then some elements of the required pre-surgical assessments may be incorporated into the H&P.
Click the link below to view the complete memo from CMS.
Supporting Documents: CMS H&P Memo
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