Bill proposes delay in PPS for surgery centers
At press time, several ambulatory surgery groups were seeking a delay in the prospective payment system (PPS) for ambulatory surgery centers. The groups had succeeded in having a bill, the Amended Beneficiary Improvement and Protection Act of 2000 (HR 5291) passed by the House Commerce Committee. Two more committees were scheduled to review the bill at press time.
The bill would do the following:
• Delay the implementation of ambulatory payment classifications (APCs) until Jan. 1, 2002. The outpatient PPS is based on APCs. The final APC regulation for surgery centers had been scheduled to be published this month, with implementation expected in April 2001.
• Extend the current phase-in from three to four years.
• Include 1999 or later cost surveys. The bill would require the Health Care Financing Admini-stration (HCFA) to incorporate data from the 1999 Medicare cost survey or a subsequent cost survey to implement or revise the PPS. HCFA plans to conduct an ASC facility survey this year.
This bill closely mirrors recommendations submitted by the Federated Ambulatory Surgery Association in Alexandria, VA; the American Association of Ambulatory Surgery Centers in Mundelein, IL; and several other ambulatory surgery groups. Those groups seek a five-year phase-in.
"The Balanced Budget Refinement Act of 1999 required HCFA to phase in rebased rates over three years if the rates are not adjusted based upon data from this year’s cost survey, but even that is not sufficient to smooth out the wild reimbursement swings that will result from these changes," the ambulatory groups state in their recommendations.
In other news, a survey by the Chicago-based American Hospital Association (AHA) indicates that most providers are receiving less money under the hospital outpatient PPS than they were a year ago.
Nearly 91% of the 525 hospitals that responded to the survey, which was distributed Sept. 15, said they had submitted claims under the outpatient PPS. However, only 80% of the survey participants said they had received a payment. Of those who have received a payment, 67% said they received less money from bills paid during Sept. 11-17, 2000, than during the corresponding week a year ago.
Also, more than 23% of respondents said they have had to hire or assign additional staff to process bills under the new system.
HCFA is still fine-tuning the system. At press time, HCFA planned to issue a program memorandum with a small number of technical corrections regarding transitional pass-through payments for devices and drugs. The program memorandum will be made available through the HCFA Web site (www.hcfa.gov).
In more news, HCFA has delayed implementation of its provider-based regulation from Oct. 10, 2000, to Jan. 10, 2001. Because of the way the regulation will be phased in, some hospitals won’t be affected until 2002. The delay will give hospitals additional time to prepare and allow HCFA to provide additional guidance, the agency says. "In addition, this delay and phase-in process would allow a more manageable distribution of work for hospitals, HCFA regional offices, and contractors," according to HCFA.
The AHA had requested the delay.
Under the provider-based rules, if a physician practice meets certain criteria and is owned by a hospital, that practice can be designated as "provider-based" and be paid more under hospital outpatient department rates.
HCFA will phase in the criteria over 12 months, based on the cost-reporting period of the facility. If a facility’s cost-reporting period is Jan. 1 through Jan. 1, the hospital would not have to implement the new criteria until Jan. 1, 2002.
A hospital must meet the new criteria on the first annual payment reporting date after Jan. 10, 2001.
At press time, HCFA planned to hold a "town hall" meeting on the provider-based regulation in Baltimore by the end of October. For more information, see HCFA’s Web site. (www.hcfa.gov.)
In other APC developments: A new program memorandum (A-00-61) updates coding information for the hospital outpatient PPS and can found at www.hcfa.gov/pubforms/transmit/A0061.pdf. The update provides hospitals a list of descriptors for drugs, biologicals, and devices eligible for transitional pass-through payments and for items classified in "new technology" ambulatory payment classifications.
Another program memorandum, which can be found at www.hcfa.gov/pubforms/transmit/A0063.pdf, includes information regarding cost-to-charge ratios for calculating certain payments under the outpatient PPS.
HCFA has posted additional "frequently asked questions" with answers regarding the processing of outpatient PPS claims and pass-through devices. (For more frequently asked questions, go to www.hcfa.gov/medlearn/refopps.htm .)
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