Infection Control
Another challenge is that the guidelines are not always fully specified or
may change as the program evolves. For example, in 2012, ASCs are supposed to report the G-codes on claims where Medicare is the primary
payer. But, starting in January, they need to include these codes on claims
where Medicare is primary or secondary. This may make it a bit trickier for
sites when Medicare is the secondary payor. Its possible primary payors
may reject the claim based on the G-codes.
Q: How well have surgery centers managed the change so far?
AE: These measures have changed the workflow, which can be really difficult. There have absolutely been some growing pains with figuring out the
most efficient way to get these codes on the bill and out the door to ensure
accounts receivable aren't impacted.
What has been particularly helpful for many ASCs has been the information on
the ASCA website about the changes. For example, they have a cheat sheet that
gives clear and concise information about handling these claims. These types
of resources are helpful reminders for coders and billers in particular.
Q: Are there any tricks for surgery centers to make sure they
are submitting these claims correctly?
AE: It's really important for surgery centers to know that they have to code
when something happens and also code if nothing happened. They must
include a code no matter what.
Sites should ensure someone, most likely the coder or biller, is tasked with
reviewing the remittance advice notices from CMS. This will help sites confirm if the G-codes were actually passed into the system. Data reports are
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Accreditation Association for Ambulatory Health Care. info@aaahc.org /
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MedBridge Billing. jlamz@medbridgebilling.com /
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Physicians' Capital Investments. jturner@physcap.com /
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Source Medical. info@sourcemed.net / www.sourcemed.net /
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47
incredibly useful as well. The threshold for reporting is 50 percent, meaning ASCs will not face the 2 percent payment reduction in 2014 if they
successfully report the G-codes on 50 percent of their Medicare claims.
Q: What additional changes should ASCs be prepared for in
the future?
AE: This is just one phase of the program. In 2013, we'll see the safe
surgery checklist and procedure volume reporting. The mechanism they've
been using to report the initial five measures will also change; starting in
July of 2013, they will have to go to the CMS QualityNet website to report
their total surgical care volume and use of a safe surgery checklist.
That means they have to have someone enter that information. Though ASCs
don't have a lot of extra people sitting around with free time, having someone
watching these measures will make sure they are on top of what is coming.
As of right now, reporting influenza vaccination coverage among healthcare professionals will be added as a measure in 2014 and most articles you
read indicate that more requirements will be added in the following years.
For software platforms, the idea is that you are going to have to have the
ability to report on these measures in some kind of electronic format. That
is the best way to go, whether it's a product like ours or something else. You
should be able to enter that information and pull a report based on data
elements and not comb through handwritten nursing documentation. It's a
big challenge for ASCs to handle. n
Contact Laura Miller at lmiller@beckershealthcare.com.
