Beginning in 2012, the Centers for Medicare and Medicaid Services (CMS) implemented the Ambulatory Surgical Center Quality Reporting (ASCQR) Program, which mandated a 2.0% payment adjustment each year for non– or unsuccessful participating ASCs starting with 2012 dates of service for 2014 payments.
To avoid the 2014 2.0% payment adjustment, ASCs had to submit QDCs for five measures on 50% of primary Medicare claims for 2012 dates of service. To avoid the 2015 2.0% payment adjustment, ASCs had to submit QDCs for five measures on 50% of primary and secondary Medicare claims for 2013 dates of service and had to report two web-based measures in July-August 2013 for 2012 dates of service.
To avoid the 2.0% payment adjustment penalty in 2016, ASCs must participate in all of the following ways in 2014 & 2015:
1. Submit quality data codes for claims-based Measures 1-5 on at least 50% of all Medicare Primary and Secondary claims for 2014 dates of service prior to April 2015.
2. Submit web-based data for Measures 6-7 and 9-11 between January and August 2015 as follows:
- Measure 6 attests to the use of a safe surgery checklist for 2014 dates of service,
- Measure 7 lists volume data on selected procedures for 2014 dates of service, and
- Measures 9-11 cover percentages of performance on chart-abstracted sample data for April-December 2014 dates of service. (Although these measures are for colonoscopies and cataract surgeries, all ASCs, regardless of specialty or case mix, will be required to report them. Presumably, for ASCs who do not perform these types of services, the denominator and numerator will both be 0, and they will report 0%.).
3. Submit data about influenza vaccination coverage among all health personnel for Measure 8 to the CDC’s National Healthcare Safety Network (NHSN) between October 2014-March 2015 (http://www.cdc.gov/nhsn/ ).
New for the 2014/2015 reporting year (2016 Payment Adjustment year), ASCs with fewer than 240 Medicare Primary and Secondary claims per year (60 per quarter) are not required to participate. Also, ASCs can choose to withdraw from the ASCQR program to avoid results being made public, but doing so automatically subjects ASCs to the 2.0% payment adjustment for that year.
What should you do now?
- Determine today if you are already participating in ASCQR.
- If you are participating, continue submitting quality data for 2013 so that you can avoid the 2015 payment adjustment.
- Also, plan to continue participation in 2014. Specifically, continue submitting quality data for measures 1-5, ensure you are using a safe surgery checklist, and review measures 8-11 to ensure your facility utilizes vaccination coverage and documentation guidelines to sufficiently report these measures which are new for 2014. Download the most recent Specifications Manual for more information on the program and individual measures. (There are no web-based measures to report for 2013 dates of service in 2014. However, you will have to report web-based measures for 2014 dates of service in 2015.)
- If you are not participating, begin participating today.
- Register for and/or maintain active Quality Net Security Administrators to ensure access for submitting web-based data again in 2015 (https://www.qualitynet.org/ ).
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