COMBINED HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (OPPS) AND AMBULATORY SURGERY CENTER (ASC) PROSPECTIVE PAYMENT SYSTEM (PPS)
2013 PROPOSED RULE RELEASED: ASC PPS 2013 CONVERSION FACTOR IS $43.190
This evening, ASCRS reviewed the proposed rule that updates rates paid under the ASC PPS. The proposed ASC PPS 2013 conversion factor is $ $43.190 which is slightly higher than last year’s conversion factor of $42.329. The rule will be published in the Federal Register on July 13, 2012.
ASC Conversion Factor
The 2013 ASC conversion factor is calculated by updating last year’s conversion factor by CPI-U (2.2) and adjusting it by the congressionally mandated multifactor productivity (MFP) adjustment (1.3%). The combination results in an MFP-adjusted update factor of 0.9%. This, coupled with a wage adjustment for budget neutrality of 1.0002, results in the final CY 2013 conversion factor of $43.190.
ASC Payments Background
CMS was mandated by Congress (via the Medicare Modernization Act (MMA) of 2003) to implement a new ASC payment system no later than January 1, 2008. The new ASC prospective payment system (PPS), which is now fully implemented, links ASC payments to hospital outpatient department (HOPD) payments.
Despite efforts by the ASC community to convince CMS that ASC’s should receive the same inflation update (market basket) as HOPDs, the final rule, once again, denotes that the ASC conversion factor will be updated by the Consumer Price Index for Urban Consumers
(CPI-U).
ESTIMATED IMPACT OF THE PROPOSED CY 2013 UPDATE TO
THE ASC PAYMENT SYSTEM ON AGGREGATE CY 2013 MEDICARE
PROGRAM PAYMENTS BY SURGICAL SPECIALTY OR ANCILLARY ITEMS
AND SERVICES GROUP
Surgical Specialty Group | Estimated | Estimated CY 2013 |
Eye and ocular adnexa | $1,448 | 1% |
ESTIMATED IMPACT OF UPDATE TO CY 2013
ASC PAYMENT SYSTEM ON AGGREGATE PAYMENTS FOR SELECTED
PROCEDURES
HCPCS | Short Descriptor | Allowed | Estimated CY 2013 |
66984 | Cataract surg w/iol, 1 stage | $1,076 | 1% |
66982 | Cataract surgery, complex | $83 | 1% |
66821 | After cataract laser surger | $55 | 6% |
15823 | Revision of upper eyelid | $39 | -1% |
ASC Quality Reporting (ASCQR) Program
CMS is authorized under the “Extension Act of 2006” to require ASCs to submit data on quality measures and to reduce the annual payment update in a year by 2.0 percentage points for ASCs that fail to do so. The rule proposes requirements regarding the dates for submission, payment, and completeness for claims-based measures; as well as how the payment rates would be reduced for ASCs that fail to meet program requirements beginning in CY 2014.
In April, CMS released the list of G-codes that ASCs will be required to include on Medicare claims with dates of service on or after October 1, 2012 for the CY2014 payment determination. ASCs that fail to include these codes will face reductions in their future Medicare reimbursements. Initially ASCs will report data, for Medicare claims only, on five measures using quality data G codes. The G-codes correspond to whether or not a Medicare patient had a burn, a fall, a wrong site/side/patient/procedure/implant event, a hospital transfer and/or on-time prophylactic antibiotics.
ASCRS will continue to work with CMS as implementation of the new ASC quality reporting program continues.
We will provide detailed information regarding additional proposed changes in future editions of Washington Watch Weekly.
A copy of the proposed rule is now available on ASCRS web site. Additional information about the 2013 ASC PPS Proposed Rule will be included in upcoming editions of Washington Watch Weekly. For more information please contact, Jenny Liljeberg, Associate Director of Regulatory Affairs, at jliljeberg@ascrs.org or Nancey McCann, Director of Government Relations, at mccann@ascrs.org