Becker's ASC Review

70 CODING & BILLING CMS proposes 2% ASC pay increase in 2019: 5 key notes By Laura Dyrda I n a 761-page proposal, CMS released the 2019 proposed payment rule for ASCs and hospital outpatient departments, addressing payment factors and potential changes in the quality reporting system, according to an ASCA report. Here are five things to know: 1. e proposed rule would increase payment to ASCs on all covered procedures by 2 percent on average. e rate increase is a combina- tion of the 2.8 percent inflation update based on the hospital market basket as well as a 0.8 percent reduction as mandated by the ACA. While reimbursement would increase by 2 percent on average, the difference is code-specific, so not all procedures will see that update. 2. CMS also proposed aligning the update factors, which would move the ASCs to the same market basket used to update HOPD pay- ments from the 2019 to 2023 calendar year. "ASCs use the same staff, services and supplies as hospital outpatient departments so it only makes sense to apply the same inflation rate for our yearly updates," said Ambulatory Surgery Center Association CEO Bill Prentice. 3. In the proposed rule, CMS would revise the definition of "surgery" for the ASC payment system to account for "surgery-like" procedures assigned codes outside of the CPT range. e agency also proposed adding 12 cardiac catherization procedures to the covered list. Although CMS removed total knee replacements from the inpatient- only list at the beginning of 2018, the 2019 proposal does not add total joints to the ASC payable list. 4. CMS addressed device-intensive procedures in their proposed rule, defining a device-intensive procedure as those with a device that takes greater than 30 percent of the total charge, lowered from the current 40 percent threshold. 5. Within the 2019 proposal, CMS addresses the ASC Quality Reporting Program. e agency could make big changes, includ- ing removing eight measures from required reporting for 2020 and 2021 payment determinations. e measures proposed for removal include: • ASC-8: Influenza Vaccination Coverage Among Healthcare Personnel • ASC-1: Patient Burn • ASC-2: Patient Fall • ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Proce- dure, Wrong Implant • ASC-4: All-Cause Hospital Transfer/Admission • ASC-9: Endoscopy/Polyp Surveillance Follow-Up Interval Normal for Colonoscopy in Average Risk Patients • ASC-10: Endoscopy: Endoscopy/Polyp Surveillance: Colo- noscopy 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 "e reduction of measures in the ASC Quality Reporting Program demonstrates the outstanding performance of ASCs in preventing serious adverse events and a finding by CMS that it is no longer necessary to collect this data," said Mr. Prentice. "We look forward to working with CMS staff to identify new measures that focus on patient outcomes and provide actionable data that can be used by patients, providers and regulators." n Pain physician faces insurance fraud, perjury after referring workers comp cases to ASC, lab he owned: 3 key notes By Laura Dyrda S anjoy Banerjee, MD, a pain physician in Corona, Calif., has been charged with workers compensa- tion insurance fraud and perjury by the Riverside County District Attorney. Here are three things to know: 1. Dr. Banerjee is accused of billing workers compensa- tion for more than $180,000 in urine toxicology testing and epidural injections he illegally self-referred to a laboratory and office-based surgical center he owned. He is the owner of Rochester Imperial Surgical Center in Wildomar, Calif. 2. Previously, Dr. Banerjee signed five doctor's reports declaring under penalty of perjury that he didn't self- refer the patients to his lab and surgical center. 3. On May 29, Dr. Banerjee was charged with two counts of insurance fraud and five counts of perjury. n ASCs use the same staff, services and supplies as hospital outpatient departments so it only makes sense to apply the same inflation rate.

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