Becker's ASC Review

24 Coding, Billing & Collections • Medicaid: 6 percent • Worker's compensation: 5 percent • Self pay: 3 percent 2. CMS bases its reimbursement for outpatient procedures on its Hospital Out- patient Prospective Payment System and Ambulatory Surgical Center Payment System. CMS released its proposed OPPS/ASC CY 2016 changes in July. CMS proposes to update OPPS rates by -0.1 percent, based on a hospital market basket increase of 2.7 percent with a -0.6 percent adjustment for multi-factor productivity and a -0.2 percent point adjustment requirement by law. 3. ASC payments are updated on an annual basis based on the Consumer Price Index for all urban consumers. For CY 2016, CMS proposes a 1.7 per- cent CPI-U update. With a multi-factor productivity adjustment of 0.6 per- cent, the update is expected to be 1.1 percent. 4. ASC reimbursement as a percentage of hospital outpatient department re- imbursement has been steadily declining since 2003, according to Medicare Payment Advisory Commission data. • 2003: 87 percent • 2008: 63 percent • 2009: 59 percent • 2010: 58 percent • 2011: 56 percent 5. CMS reimbursement is affected by quality reporting requirements. Am- bulatory Surgical Center Quality Reporting Program measures for CY 2016 payment determination include: • ASC-1 Patient burn • ASC-2 Patient fall • ASC-3 Wrong site, wrong side, wrong patient, wrong procedure, wrong implant • ASC-4 Hospital transfer/admission • ASC-5 Prophylactic intravenous antibiotic timing • ASC-6 Safe surgery checklist use • ASC-7 ASC facility volume data on selected ASC surgical procedures • ASC-8 Influenza vaccination coverage among healthcare personnel Surgery centers who do not meet reporting requirements may incur a 2 per- centage point reduction to any annual increase provided under the ASC pay- ment system for that year. 6. In July, CMS also proposed adding 11 new procedures to its ASC payable list next year. e new procedures and codes include: • 07101T for "insertion of posterior spinous process distraction device including necessary removal of bone or ligament for insertion and im- age guidance, lumbar; single level." • 0172T for "insertion of posterior spinous process distraction device in- cluding necessary removal of bone or ligament for insertion and image guidance, lumbar; each additional level." SPINE is Making its MOVE to ASCs ARE YOU? Develop a Spine ASC Succeed with a proven strategic partner Control your surgical environment Meet patients' expectations for minimally invasive spine surgery Spine ASC Partnerships Acquisition Development Management Make your move with us! 615-301-8142 www.meridiansurgicalpartners.com 8 Things to Know About ASC Reimbursement (continued from cover)

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