Becker's ASC Review

48 CODING & BILLING CMS considers nixing 'burdensome' ASC, HOPD requirements — 5 notes By Angie Stewart C MS proposed eliminating "unnecessary, obsolete or excessively burdensome," Medicare regulations for ASCs and other healthcare facilities. Here's what you should know: 1. The proposed rule includes a provision to scale back hospital outpatient and ASC requirements for conducting comprehensive medical histories and physical assessments. The agency proposes replacing comprehensive medical history and physical assessment regulations with requirements that defer to the ASC's policy and/or physicians' judgement. 2. CMS also proposes removing the requirement for a written hospital transfer agreement or hospital physi- cian admitting privileges. 3. Other provisions include allowing multi-hospital systems to have uni- fied and integrated Quality Assess- ment and Performance Improvement programs for all member hospitals; simplifying the ordering process for portable X-rays and removing dupli- cative ownership disclosure require- ments for critical access hospitals. 4. CMS gathered stakeholder input, visited healthcare facilities and organized work groups to develop the rule. The agency has addressed 55 percent of issues it uncovered regarding burden and continues to address others. 5. CMS estimates the policy would save $1.12 billion annually. Com- bined with rules finalized since the initiative began, the proposal would save an estimated $5.2 billion and 53 million hours by the end of 2021. "The changes we're proposing will dramatically reduce the amount of time and resources that healthcare facilities have to spend on CMS- mandated compliance activities that do not improve the quality of care, so that hospitals and healthcare pro- fessionals can focus on their primary mission: treating patients," said CMS Administrator Seema Verma. n ASCs to receive 2.1% increase in 2019 Medicare reimbursement: 6 things to know By Laura Dyrda C MS released the 2019 final payment rule for hospital outpatient surgery departments and ASCs, including an average rate adjustment on procedures, ac- cording to a statement from the Ambulatory Surgery Center Association. Here are six things to know: 1. ASCs will receive a 2.1 percent reimburse- ment rate increase on average per procedure. HOPDs will receive a 1.35 percent average rate increase next year. "I think these chang- es will incentivize physician owners to bring more Medicare cases to the ASC, particularly device-intensive procedures," said William Prentice, CEO of ASCA. 2. Device-intensive procedures are now defined as those with a "device offset per- centage greater than 30 percent based on the standard OPPS APC rate-setting methodol- ogy." is is down from the pervious thresh- old, which was 40 percent. 3. CMS reviewed several codes that were added to the ASC payable list over the past three years and has decided to keep the codes, including some spinal proce- dure codes, on the ASC payable list. ASCA expected these codes to remain on the list, which will allow surgeons to continue per- forming them at ASCs. 4. CMS will now make separate payments for non-opioid pain management drugs for ASCs. e only HCPCS code falling into this category is Exparel, which will now receive separate payment when used in the ASC. 5. e definition of "surgery" expanded under the ASC payment system to include select "surgery-like" procedures, such as 12 cardiac catheterization procedures. e agency added five additional cardiac cath- eterization procedures to the ASC covered list as well. "As ASCs continue to show the ability to safely migrate more commercial procedures, we expect CMS to respond appropriately and expand the list of reimbursable proce- dures for Medicare beneficiaries," said Mr. Prentice. "is definitional change will allow surgery centers with the right expertise to perform these procedures, with great savings for the Medicare system." 6. Two of the eight measures CMS pro- posed to remove from the quality reporting program were approved. Beginning in 2020, CMS will remove "ASC-8: Influenza Vaccina- tion Coverage Among Healthcare Person- nel," and in 2021 remove, "ASC-10: Endosco- py/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use." e agency le ASC-1, 2 and 3 on the list but suspended data collection for them until the measures could be revised. "e reduction of measures in the ASC Quality Report- ing Program demonstrates the outstanding performance of ASCs in preventing serious adverse events. We look forward to working with CMS staff to identify actionable quality data that can be used by patients, provid- ers and regulators," said Mr. Prentice in the AWSCA statement. While many of these changes are positive for ASCs, ASCA will continue advocating for beneficial changes. "As great as the payment policy changes in this rule are, we know there are additional incentives in terms of payment policy that could dramatically increase procedure migration and bend the cost curve for Medicare," said Mr. Prentice. "We look forward to working with CMS on those in 2019 and beyond." n

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