Becker's ASC Review

25 CODING & BILLING 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 previous 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 catheterization proce- dures 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 Reporting Program demonstrates the outstanding perfor- mance 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, providers and regulators," said Mr. Prentice in the ASCA statement. While many of these changes are positive for ASCs, ASCA will continue advocat- ing 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 Eye Centers of Florida pays $525K to settle Medicare billing fraud allegations: 5 things to know By Laura Dyrda E ye Centers of Florida, based in Fort Myers, plans to settle Medicare billing fraud allegations with a $525,000 pay- ment, according to the Naples Daily News. Here are five things to know: 1. The U.S. Attorney's Office accused Eye Centers of Florida employees of altering medical records to lower patient scores on vision tests. As a result, the patients became candidates for cataract surgery. 2. The alleged fraud took place from Jan. 1, 2012, to March 1, 2014, and included Advantica Medicare plan patients. 3. Two former Eye Centers of Florida employees were whistleblowers in the case. 4. Eye Centers of Florida agreed to settle the allegations with a $525,000 payment, and the whistleblowers received $115,000. 5. The practice has 11 locations in Florida, including the SurgiCare Center ASC. n

• Cover