Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

2015 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 2015, the CPI-U is projected to be 1.9 percent. After applying an additional multi-factor productivity adjustment of 0.5 percent, the payment update rate for 2015 is 1.4 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 2015 will be adjusted based on the 2013 ASCQR Program reporting period. According to CMS, 98.9 percent of the ambulatory surgical centers subject to the ASCQR Program met those requirements and will receive the full annual payment update for 2015.

A list of providers who met the 2015 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 2013 reporting year were notified by a letter sent on November 10, 2014. 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, 2015.

In the 2015 ASC Final Rule with Comment Period, CMS made the following changes to the ASCQR Program:

  • First, a new claims-based outcome-based measure was added: ASC-12: Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy for the CY 2018 payment determination and subsequent years.
  • In addition, CMS is excluding one previously adopted measure from the measure set for the CY 2016 payment determination ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery) and changing this measure from required to voluntary for the CY 2017 payment determination and subsequent years. Facilities will not be subject to payment reductions with respect to ASC-11 while the measure is voluntary.
  • CMS also is adopting criteria for determining when to remove a measure for the ASCQR Program and is refining the “topped out” criteria previously adopted for the Hospital OQR Program so that the same criteria are used for both programs and is consistent with other quality reporting programs, including the Hospital IQR Program.

In general, the following measures should be reported in 2015:

Claims-Based Measures for 2015 dates of service to determine 2017 payment rate:

  • ASC-1: Patient Burn
  • ASC-2: Patient Fall
  • ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant
  • ASC-4: Hospital Transfer/Admission
  • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing
  • ASC-12: Facility Seven-Day Risk Standardized Hospital Visit Rate after Outpatient Colonoscopy (NOTE: Though this new claims-based measure should be reported in 2015, CMS has indicated that it will not affect payments until 2018 [reported for 2016 DOS]).

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 for 2014 dates of service to determine 2016 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
  • ASC-9: Endoscopy/Polyp Surveillance: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Patients (NOTE: April-December 2014 DOS only)
  • ASC-10: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use (NOTE: April-December 2014 DOS only)
  • ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (NOTE: Data Submission Voluntary and applies to April-December 2014 DOS only)

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

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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