Issue link: https://beckershealthcare.uberflip.com/i/883254
20 PRACTICE MANAGEMENT CMS Proposes 1.9% Increase in 2018 ASC Pay, Adding Total Joint Replacements — 5 Insights By Eric Oliver C MS released a proposed rule that would update the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System. Here's what you should know about the ASC related changes: 1. CMS is proposing to increase payment rates by 1.9 percent to ASCs that meet quality reporting requirements. CMS based the in- crease on an adjusted consumer price index in accordance with the ACA. 2. CMS estimates total payments to ASCs in 2018 would be around $4.68 billion, which is an increase of $155 million over 2017. 3. In relation to the payments, CMS is solic- iting comments related to payment reform in the following areas: • e rate update factor applied to pay- ments • How ASCs submit cost-related data • Whether ASCs should use an institu- tional claim form • Other ideas to improve payment accu- racy 4. CMS is soliticing comments on whether three procedures should be added to the ASC covered procedures list. ey are: • Total knee arthroplasty • Partial hip arthroplasty • Total hip arthroplasty e agency is also seeking comments on whether there are codes not listed in the American Medical Association's Current Pro- cedural Terminology surgical code range that should be covered. 5. Concerning the ASC quality reporting pro- gram, the agency is proposing to adopt mea- sures for the 2019, 2021 and 2022 payment determinations. For 2019, CMS wants to remove: • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing • ASC-6: Safe Surgery Checklist Use • ASC-7: Ambulatory Surgical Center Fa- cility Volume Data on Selected Ambula- tory Surgical Center Surgical Procedures Starting in 2018, CMS would expand its on- line tool to allow for batch submission of measure data and it would align the Extraor- dinary Circumstances Exceptions policy with other programs. For 2021, CMS wants to add a measure re- lated to toxic anterior segment syndrome. In 2022, CMS wants to add two measures relat- ed to hospital visits aer both orthopedic and urology procedures. n Oklahoma Orthopedic Practice Pays for Billing Irregularities in $1.5M Settlement: 7 Things to Know By Megan Wood O rthopedic and Sports Medicine Center-Norman (Okla.) found a billing problem in August 2016, ac- cording to The Norman Transcript. Here are seven things to know: 1. The practice and its physician owners immediately con- tacted HHS' Office of Inspector General's Office of Investi- gations and Office of Audit Services to voluntarily disclose the discovered billing irregularities and documentation deficiencies. 2. Following the disclosure, the government investigated the billing problems. 3. Orthopedic and Sports Medicine Center's physicians Mark Moses, MD, David Bobb, MD, William Harris, MD, Vytautus Ringus, MD, Steven Schultz, MD, and Brad Vogel, MD, paid about $1.54 million to settle a civil claim suit. 4. The United States and State of Oklahoma alleged the practice submitted false claims to Medicare, Medicaid, the Department of Veterans Affairs and TRICARE. 5. Between Jan. 1, 2010, and Dec. 31, 2015, the practice did not bill the following correctly, according to The Nor- man Transcript: • Physician extenders without documentation in prog- ress notes to support billing, evaluation and manage- ment codes • Durable medical equipment, prosthetics, orthotics and supplies issues • Evaluation and management codes regarding hospi- tal consults • Physical therapy with documentation that didn't sup- port CPT codes billed and/or the number of physical therapy units billed 6. Orthopedic and Sports Medicine Center cooperated during the investigation, providing access to privileged and non-privileged internal documentation, audit and medical records. 7. The practice did not claim liability in the settlement. n