2013 ASC Proposed Rule Released by xiaopangnv

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									TO: All ASCRS/ASOA Members
Date: July 6, 2012

     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

                              Estimated
                                                              Estimated CY 2013
Surgical Specialty             CY 2013
                                                               Percent Change
     Group                  ASC Payments
                             (in Millions)
 Eye and ocular
                                 $1,448                               1%
    adnexa

                      ESTIMATED IMPACT OF UPDATE TO CY 2013
             ASC PAYMENT SYSTEM ON AGGREGATE PAYMENTS FOR SELECTED
                                   PROCEDURES
                                       Allowed
HCPCS                                                         Estimated CY 2013
             Short Descriptor          Charges
 Code                                                          Percent Change
                                       (in mil)
       Cataract surg w/iol, 1
 66984                            $1,076                               1%
       stage
       Cataract surgery,
 66982                              $83                                1%
       complex
       After cataract laser
 66821                              $55                                6%
       surger
 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 nmccann@ascrs.org

								
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