The Ambulatory Surgery Center Association will host a webinar on Dec. 8 describing the details of Medicare's new quality reporting program for ASCs. In preparation for the webinar, the ASCA has answered some of the most frequently asked questions about the new quality reporting program.
ASC leaders can register for the ASCA webinar here and submit additional questions to the Member Services Team at asc@ascassociation.org.
Q: Will Medicare evaluate our performance based only on whether we report the data as required or also based on the data results? In other words, will CMS penalize us if we fail to meet certain benchmarks?
A: This is a data reporting requirement only. If you report the required data, you will be in compliance with the requirement. Your ASC will not be penalized for what the data indicate. For example, in 2013, the Centers for Medicare & Medicaid Services will ask ASCs to report whether they used a safe surgical checklist during the 2012 calendar year. As long as your ASC informs CMS about whether you used a safe surgery checklist, you have fulfilled your reporting obligation. CMS will not penalize ASCs for failing to use a safe surgery checklist.
Q: How will the 2 percent penalty be calculated and applied?
A: An ASC that does not successfully report data to the Medicare program in 2012 will have its Medicare payments reduced by 2 percent in 2014. CMS will identify ASCs by their CMS Certification Number, formerly called the Medicare Provider Number. If a facility does not submit quality data beginning October 1, 2012, CMS will reduce the 2014 ASC conversion factor for that center by 2 percent, which will cause all claims to be paid at a lower rate. For example, if the conversion factor for the year was $40.00, payments to a non-reporting ASC would start at a base rate of $39.20. That new "starting point" would then be multiplied by the relative weight for each service and adjusted by the wage index to arrive at the reimbursement amount for an individual center.
Failure to report in subsequent years will affect future years’ payments to the same extent. For example, an ASC that fails to report in 2013 will see its payments reduced in 2015. The penalties will not be cumulative, however; an ASC that fails to report in 2012 but successfully reports in 2013 will receive full payments in 2015.
Q: Do we have to report data for Medicare patients only or for all patients?
A: It depends on the reporting measure. Starting October 1, 2012, ASCs must include on the CMS-1500 (Health Insurance Claim Form), for Medicare services provided, quality data codes for the following five measures: 1. Patient Burn; 2. Patient Fall; 3. Wrong Site, Side, Patient, Procedure, Implant; 4. Hospital Admission/Transfer; and 5. Prophylactic IV/Antibiotic Timing. These measures must be reported only for Medicare patients. For example, your facility would only report a fall when it involves a Medicare patient. CMS will announce the CPT Category II or HCPCS Level II G codes that should be used to describe the quality in the second quarter of 2012.
By contrast, beginning in 2013, ASCs will be required to report their total — Medicare and non-Medicare — 2012 surgical volume for certain specified procedures.
The other two announced measures, Safe Surgery Checklist Use and Influenza Vaccination Coverage Among Healthcare Personnel, are not patient-specific; they apply to the operation of the ASC.
Related Articles About ASC Quality:
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ASC leaders can register for the ASCA webinar here and submit additional questions to the Member Services Team at asc@ascassociation.org.
Q: Will Medicare evaluate our performance based only on whether we report the data as required or also based on the data results? In other words, will CMS penalize us if we fail to meet certain benchmarks?
A: This is a data reporting requirement only. If you report the required data, you will be in compliance with the requirement. Your ASC will not be penalized for what the data indicate. For example, in 2013, the Centers for Medicare & Medicaid Services will ask ASCs to report whether they used a safe surgical checklist during the 2012 calendar year. As long as your ASC informs CMS about whether you used a safe surgery checklist, you have fulfilled your reporting obligation. CMS will not penalize ASCs for failing to use a safe surgery checklist.
Q: How will the 2 percent penalty be calculated and applied?
A: An ASC that does not successfully report data to the Medicare program in 2012 will have its Medicare payments reduced by 2 percent in 2014. CMS will identify ASCs by their CMS Certification Number, formerly called the Medicare Provider Number. If a facility does not submit quality data beginning October 1, 2012, CMS will reduce the 2014 ASC conversion factor for that center by 2 percent, which will cause all claims to be paid at a lower rate. For example, if the conversion factor for the year was $40.00, payments to a non-reporting ASC would start at a base rate of $39.20. That new "starting point" would then be multiplied by the relative weight for each service and adjusted by the wage index to arrive at the reimbursement amount for an individual center.
Failure to report in subsequent years will affect future years’ payments to the same extent. For example, an ASC that fails to report in 2013 will see its payments reduced in 2015. The penalties will not be cumulative, however; an ASC that fails to report in 2012 but successfully reports in 2013 will receive full payments in 2015.
Q: Do we have to report data for Medicare patients only or for all patients?
A: It depends on the reporting measure. Starting October 1, 2012, ASCs must include on the CMS-1500 (Health Insurance Claim Form), for Medicare services provided, quality data codes for the following five measures: 1. Patient Burn; 2. Patient Fall; 3. Wrong Site, Side, Patient, Procedure, Implant; 4. Hospital Admission/Transfer; and 5. Prophylactic IV/Antibiotic Timing. These measures must be reported only for Medicare patients. For example, your facility would only report a fall when it involves a Medicare patient. CMS will announce the CPT Category II or HCPCS Level II G codes that should be used to describe the quality in the second quarter of 2012.
By contrast, beginning in 2013, ASCs will be required to report their total — Medicare and non-Medicare — 2012 surgical volume for certain specified procedures.
The other two announced measures, Safe Surgery Checklist Use and Influenza Vaccination Coverage Among Healthcare Personnel, are not patient-specific; they apply to the operation of the ASC.
Related Articles About ASC Quality:
6 Oversights That Can Cause Trouble for an ASC
Faulty Smoke Detector Forces Evacuation of Mississippi Surgery Center
How to Clean a Surgery Center's OR According to AAAASF Standards
