At the 20th Annual Ambulatory Surgery Centers Conference in Chicago on October 25, Regina Boore, RN, the principal and CEO of Progressive Surgical Solutions, discussed the evolving CMS mandates for quality reporting by ASCs and how it will affect their reimbursements.
According to Ms. Boore, the benefits of quality reporting have not yet been established. "The jury is still out," she said. Hospitals have quality reporting, but it hasn't been proven that it leads to better outcomes. ASCs are, thus far, required to report on claims-based measures, structural measures and influenza vaccination amongst healthcare workers. Here are four things ASC administrators need to know regarding reporting mandates:
1. Claims-based reporting became effective in October 2012. If an ASC does not report for the three-month period between October and December 2012, the surgery center will be penalized with a 2 percent cut to its reimbursement rate in 2014, said Ms. Boore.
2. To report Medicare claims, G-Codes need to be used. But it is important to remember that if a G-Code is wrong, you cannot resubmit the claim just to change the code, said Ms. Boore. If the claim needs to be resubmitted due to some other error, then a G-Code that is wrong can be fixed.
3. Reporting on structural measures began this year and will affect 2015 reimbursement rates, said Ms. Boore. If a surgery center fails to report on structural measure in 2013, it will face a 2 percent cut in reimbursements in 2015.
4. Collection of data on influenza vaccination amongst healthcare workers needs to begin in 2014, said Ms. Boore. Reporting on this measure will affect 2016 reimbursements. The vaccination needs to be offered to everyone at the surgery center, from students and trainees to employees. "You will need to record how many accepted the vaccine," said Ms. Boore.
"We are being paid for reporting, and eventually we will be paid for performance," said Ms. Boore. She ended the conference by advising surgery centers to benchmark their quality performance and to stay informed regarding regulatory measures.
According to Ms. Boore, the benefits of quality reporting have not yet been established. "The jury is still out," she said. Hospitals have quality reporting, but it hasn't been proven that it leads to better outcomes. ASCs are, thus far, required to report on claims-based measures, structural measures and influenza vaccination amongst healthcare workers. Here are four things ASC administrators need to know regarding reporting mandates:
1. Claims-based reporting became effective in October 2012. If an ASC does not report for the three-month period between October and December 2012, the surgery center will be penalized with a 2 percent cut to its reimbursement rate in 2014, said Ms. Boore.
2. To report Medicare claims, G-Codes need to be used. But it is important to remember that if a G-Code is wrong, you cannot resubmit the claim just to change the code, said Ms. Boore. If the claim needs to be resubmitted due to some other error, then a G-Code that is wrong can be fixed.
3. Reporting on structural measures began this year and will affect 2015 reimbursement rates, said Ms. Boore. If a surgery center fails to report on structural measure in 2013, it will face a 2 percent cut in reimbursements in 2015.
4. Collection of data on influenza vaccination amongst healthcare workers needs to begin in 2014, said Ms. Boore. Reporting on this measure will affect 2016 reimbursements. The vaccination needs to be offered to everyone at the surgery center, from students and trainees to employees. "You will need to record how many accepted the vaccine," said Ms. Boore.
"We are being paid for reporting, and eventually we will be paid for performance," said Ms. Boore. She ended the conference by advising surgery centers to benchmark their quality performance and to stay informed regarding regulatory measures.
