Becker's ASC Review

18 ASC MANAGEMENT No Surprises Act final rules: What ASCs need to know By Patsy Newitt e HHS and Labor Department Aug. 19 issued the final rules for the No Surprises Act. Here are the three changes that ASCs need to know: 1. e final rule defined the term "downcode" to mean the alteration of a service code to another service code or the removal, addition or alteration of a modifier with a lower qualifying payment amount than the service code billed. When a qualifying payment amount is based on a downcoded service code or modifier, the issuer or plan must provide the following with its initial payment: • A statement that the service code or modifier billed was downcoded • An explanation of why the claim was downcoded, including which codes or modifiers were altered • e amount the qualifying payment amount would have been had the service not been downcoded 2. Certified independent dispute resolution entities must consider the qualifying payment amount as well as all additional permissible information submitted by each party to choose an appropriate out- of-network rate. Aer weighing these considerations, independent dispute resolution entities should then select the offer that "best represents the value of the item or service under the dispute." 3. e final rules also finalized the October 2021 rule requiring certified independent dispute resolution entities to explain payment determinations and underlying rationale in a written decision sent to the HHS and Labor Department. is explanation should include the weight given to the qualifying payment amount. n Ground broken on new 87-acre Florida medical complex with ASC By Claire Wallace S ite work has begun on a new 87-acre medical complex in Panama City Beach, Fla., that will include an ASC, facilities for orthopedic surgery and cardiology, a hospital, urgent care and primary care, according to an Aug. 29 report from the Panama City News Herald. The center is being built through a partnership between Tallahassee (Fla.) Memorial Healthcare, Tallahassee- based Florida State University and St. Joe Company, a developer. The hospital building was originally slated to open with 30 to 40 inpatient beds, before expanding to 100 down the line, but due to demand, the facility may need all 100 beds now, according to the report. The medical office building on the currently-unnamed campus is expected to open sometime in 2024, with the hospital set to open in 2027. "There's a lot of great hospitals in this area, but [they] are a distance away," Andrew Starr, chief health operations officer at Tallahassee Memorial Healthcare, told the Herald. "That [creates] a real opportunity [for this campus], and also a situation that needs to be bridged as you have more and more citizens moving into this immediate area and the surrounding areas. Having a healthcare infrastructure to further support the growth and population is not a want, it's a need." n Mayo Clinic to renovate, relocate ASC By Marcus Robertson R ochester, Minn.-based Mayo Clinic Health System is spending $15 million on projects in Alber Lea, including moving and renovating an ASC, local outlet ABC 6 News reported Aug. 24. Mayo Clinic's Albert Lea hospital is relocating outpatient services to the building's second floor, the report said. It is moving ambulatory surgery to areas formerly used for behavioral health. The renovation includes 16 presurgical and postsurgical rooms and one procedure room, the report said. n New York cancer practice reopens outpatient surgery center By Marcus Robertson Buffalo, N.Y.-based Roswell Park Comprehensive Cancer Center reopened its newly renovated head and neck, dental and maxillofacial ASC. The 12,600-square-foot facility is on the third floor of the cancer center's main hospital, Roswell Park said Aug. 23. The center will serve patients with thyroid, throat, nose and sinus cavity cancers, among other ailments. The center is partnering with Philadelphia-based University of Pennsylvania to allow plastic surgeons to have a complete clinical rotation training experience. n

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