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Experience. Integrity. Advocacy.

2016 ASC Medicare Fee Schedule and ASCQR Program Updates

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The Centers for Medicare and Medicaid Services (CMS) annually updates Ambulatory Surgical Center (ASC) payments for inflation by the percentage increase in the Consumer Price Index (CPI-U) for all urban consumers. For 2016, the CPI-U is .8 percent. After applying an additional multifactor productivity adjustment of 0.5 percent, the payment update rate for 2016 is .3 percent.

That payment update rate, however, is adjusted each year for each ASC based on its performance in the Ambulatory Surgical Center Quality Reporting (ASCQR) Program. ASCs that do not meet program requirements will receive a two percent reduction in their ASC annual payment update.

Payments in 2016 will be adjusted based on the 2014 ASCQR Program reporting period. According to CMS, 6,090, or 95.9 percent, of the ambulatory surgical centers subject to the ASCQR Program met those requirements. As well, 2,551 facilities were exempt, and another 60 facilities received exceptions for “extraordinary circumstances.” All of these ASCs will receive the full annual payment update for 2016.

Another 4.1 percent, or 261 ASCs, were required to participate in the ASCQR Program but did not meet all of the requirements. These facilities will receive a 2 percent reduction of their annual payment update for 2016.

A list of providers who met the 2016 ASCQR Program requirements is available in the “APU Determinations” section of the ASC area of QualityNet.org. A list of ASCs that did not meet the requirements also is available there. ASCs not meeting the ASCQR Program requirements for the 2014 reporting year were notified by a letter sent in November 2015. An ASC may submit a request for reconsideration to CMS by completing the ASCQR Reconsideration Request form available on QualityNet.org. This form must be submitted via fax or mail to the ASCQR Support Contractor no later than March 17, 2016.

In the 2016 ASC Final Rule with Comment Period, CMS approved the following for the ASCQR Program:

  • No new measures were added. The program will continue for the 2016 reporting year with 12 measures: 11 required and 1 voluntary.
  • Two measures were offered for comment and may be added in the future: Normothermia Outcome, which assesses the percentage of patients having surgical procedures under general or neuroaxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit; and Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have an unplanned anterior vitrectomy (removal of the vitreous present in the anterior chamber of the eye).
  • ASC facilities with fewer than 240 paid claims in calendar year 2015 are not required to participate in the ASCQR Program for 2016. These facilities can voluntarily participate, however, with no risk of payment penalties.

In general, the following measures should be reported in 2016:

Claims-Based Measures

Data for 2016 dates of service should be reported on claims to determine the 2018 payment rate:

  • ASC-1: Patient Burn
  • ASC-2: Patient Fall
  • ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant
  • ASC-4: All Cause Hospital Transfer/Admission
  • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing
  • ASC-12: Facility Seven-Day Risk Standardized Hospital Visit Rate after Outpatient Colonoscopy

Quality data codes (QDCs) for claims-based measures should be included on all Medicare Part B Fee-for-Service Claims, including for Medicare Railroad Retirement Board beneficiaries and Medicare Secondary Payer claims.

Web-Based Measures

Data collected in January 1-December 31, 2015, should be submitted January 1-August 15, 2016, to determine the 2017 payment rate:

  • ASC-6: Safe Surgery Checklist Use
  • ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures
  • ASC-8: Influenza Vaccination Coverage among Healthcare Personnel (data collection period: Oct. 1, 2015-March 31, 2016; submission period: Oct. 1, 2015-May 15, 2016)
  • ASC-9: Endoscopy/Polyp Surveillance: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Patients
  • ASC-10: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use
  • ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (NOTE: Data Submission Voluntary)

Collect data in January 1-December 31, 2016, to be submitted January 1-August 15, 2017, to determine the 2018 payment rate:

  • ASC-6: Safe Surgery Checklist Use
  • ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures
  • ASC-8: Influenza Vaccination Coverage among Healthcare Personnel (data collection period: Oct. 1, 2016-March 31, 2017; submission period: Oct. 1, 2016-May 15, 2017)
  • ASC-9: Endoscopy/Polyp Surveillance: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Patients
  • ASC-10: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use
  • ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (NOTE: Data Submission Voluntary)

Data for web-based measures relate to all ASC patients (Medicare and non-Medicare). Data for web-based measures are to be submitted using a web-based tool located on the SecureQualityNet Portal at www.QualityNet.org except for ASC-8 which will be submitted through the CDC’s National Safety Health Network.

For more information, visit the Ambulatory Surgical Center Quality Reporting (ASCQR) Program page at the QualityNet website. You can also review the specific measures and submission guidelines of the program in the updated Specification Manual.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com. Photo by Patricksmercy via Flickr used with permission under the Creative Commons License.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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