By end of year, GAO to complete ASC report
FASA president offers Medicare update
The Centers for Medicare & Medicaid Services (CMS) is required by law to implement a new payment system for ambulatory surgery centers (ASCs) by Jan. 1, 2008.
CMS is directed to consider a report from the General Accounting Office (GAO) on ASC payment. The report was due Jan. 1, 2005, but is expected to be completed toward the end of 2005, said Kathy Bryant, executive vice president of the Federated Ambulatory Surgery Association (FASA) at the group’s annual meeting.
The survey will compare relative costs of hospital outpatient departments and ASCs and determine whether ambulatory payment classifications (APCs) will work for ASC procedures. About 400 surgery centers will be surveyed, according to Bryant.
GAO will request:
- an income statement;
- a list of procedures performed in the last year;
- the number of procedures by Current Procedural Terminology (CPT) code (not just Medicare).
Additionally, GAO will ask how much the center spent on areas such as entertainment and lobbying, Bryant said.
Many centers are asking if they have to participate in the survey, Bryant said. The GAO says yes.
FASA’s lawyer Ronald L. Wisor with Arent Fox in Washington, DC, says that the answer appears to be no; but if you don’t, the agency could subpoena your existing records.
The Office of Inspector General (OIG) also is studying ASCs more closely by looking at appropriate physician coding, billing services, and enrollment applications, Bryant said.
The OIG contends that in a sampling of claims for three carriers, physicians incorrectly checked where the procedure was performed 70% to 80% of the time. Send a memo to your physicians reminding them to use different site of service codes for procedures performed in the ASC, she suggested.
In terms of billing services, the OIG is examining whether ASCs are getting better reimbursement with those services and, if so, whether that increase is due to better billing practices or fraudulent billing, Bryant said.
ASCs also need to check to see if their Medicare enrollment application is up to date; for example, determine if the address is current, she explained.
According to a CMS spokesperson, centers should check with the Medicare contractor that processes their claims to update or check the enrollment application.
In other news:
- Overnight care.
CMS previously sent a letter to state surveyors saying, "An ASC that routinely provides overnight recovery stays, regardless of payment source, may no longer meet the regulatory definition of an ASC and will jeopardize its Medicare certification."
FASA receives two or three calls a week asking the status of this statement, Bryant said. The interpretation is in effect, she said, but CMS has said a clarification is forthcoming.
- Update ASC conditions of coverage.
The ASC conditions of participation have changed little since they were implemented in the mid-1980s, Bryant reported. CMS intends to issue a proposed rule late in 2005 to update the conditions of participation, she said.
- Performing non-ASC list procedures.
In a previous letter on overnight care to state surveyors, CMS said surveyors should verify that "Medicare patients are scheduled only for procedures on the CMS-approved list."
The interpretation is in effect, but CMS has told FASA that a clarification is forthcoming, Bryant said.
- New technology intraocular lenses (IOLs).
ASCs were paid an extra $50 for IOLs designated as "new technology IOLs" by CMS. The designation was good for five years. CMS recently declined to expand the ASC list to include more IOLs.
The new technology IOL designation for those previously given that label expired May 18, 2005, and the payment reverted to $150, Bryant said.
- CPT 66711, Ciliary body destruction, cyclophotocoagulation, endoscopic.
CPT 66711 inadvertently was not added to the ASC list. The code is being paid retroactive to Jan. 1, 2005, Bryant said. Centers that have not been automatically retroactively paid by their Medicare carrier can resubmit claims for cases done after Jan. 1 for payment.
The Centers for Medicare & Medicaid Services (CMS) is required by law to implement a new payment system for ambulatory surgery centers (ASCs) by Jan. 1, 2008.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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