Tag Archives: ASC

CMS Proposes Medicare OPPS, ASC Update for CY 2018

CMS has published its proposed rule to update Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment system rates and policies for calendar year (CY) 2018. In addition to proposing rate updates for the two payment systems, CMS solicits comments on a wide range of topics, including, among others:  deep OPPS … Continue Reading

CMS Corrects Final 2017 OPPS/ASC Rule, Results in Slight Payment Increase

CMS has published a notice correcting technical errors in its November 14, 2016 final rule with comment period updating the Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center payment systems for 2017.  Among many other things, CMS is correcting the OPPS weight scaler, which very slightly increases OPPS rates that are adjusted … Continue Reading

CMS Finalizes Medicare OPPS, ASC Rates and Policies for 2017

CMS has published its final rule with comment period updating the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for CY 2017.  CMS will accept comments on a limited number of provisions until December 31, 2016. Major provisions impacting outpatient hospital department services include the … Continue Reading

CMS Proposes Update to Medicare OPPS, ASC Rates and Policies for 2017

CMS has published its proposed rule to update the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for CY 2017. CMS proposes a 1.55% OPPS update, reflecting a 2.8% market basket increase, which is partly offset by a -0.5% multifactor productivity (MFP) adjustment and an … Continue Reading

Ways and Means Committee Approves Bill to Make Reforms to Medicare Hospital and Other Payment Policies

The House Ways and Means Committee has approved an amended version of H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016.”  While most of the provisions address Medicare payment policies pertaining to hospitals (including long term care hospitals (LTCHs) and hospital outpatient departments), certain other reimbursement policies, including Medicare Advantage and physician payment … Continue Reading

House Energy & Commerce Committee Seeks Comments on Medicare Site-Neutral Payment Policies

The House Energy and Commerce Committee is seeking input on Section 603 of the Bipartisan Budget Act of 2015, which established a site-neutral payment policy for newly-acquired, provider-based, off campus hospital outpatient departments (HOPD) after November 2, 2016.  In an open letter to the health care community, the Committee explains the origins of the policy, … Continue Reading

CY 2016 Medicare OPPS Spending to Drop by 0.4% under Final OPPS Rule; ASC Payments Get Small Boost

On November 13, 2015, the Centers for Medicare & Medicaid Services (CMS) is publishing its final rule updating the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year (CY) 2016. CMS estimates that total federal expenditures under the OPPS will drop by $133 … Continue Reading

CMS Sends Final 2016 Medicare Payment Rules to OMB for Review

This week CMS referred major final calendar year 2016 Medicare payment rules to the White House Office of Management and Budget (OMB) for regulatory clearance. Specifically, OMB is reviewing the final CMS rules to update the Medicare physician fee schedule, the hospital outpatient prospective payment system (PPS) and ambulatory surgical center payment update, the home … Continue Reading

CMS Seeks Suggestions for Surveys on Hospice and Hospital Outpatient Surgery Department/Ambulatory Surgery Center Care

CMS published two notices on January 25, 2013 announcing the development of surveys of patient care experiences to support the Administration’s National Quality Strategy. First, CMS is designing a Hospice Survey to help CMS understand: (1) patient experiences throughout their hospice care, as reported by bereaved family members or close friends of patients who died … Continue Reading

HHS Issues ASC Value-Based Purchasing Implementation Plan

The HHS Secretary has submitted a report to Congress outlining the Department’s plan to implement a value-based purchasing (VBP) program for Medicare payments to ambulatory surgical centers (ASCs), as mandated by the ACA. The report describes current efforts to improve quality and payment efficiency in ASCs, and examines steps required in designing and implementing a Medicare … Continue Reading

MedPAC Report to Congress on 2012 Payment Recommendations

On March 15, 2011, MedPAC released its annual report to Congress on Medicare Payment Policy. The report includes MedPAC’s recommendations on payment rate updates and other policies, such as distribution of payments and program integrity, for Medicare fee-for-service payment systems. It also includes an overview of the status of the Medicare Advantage and Medicare Part D prescription … Continue Reading

CMS Proposes Requiring Providers to Notify Beneficiaries of Right to Access QIOs

CMS published a rule on February 2, 2011 that would require certain Medicare-certified providers and suppliers to inform their Medicare beneficiaries about their right to file written quality-of-care complaints with the local Quality Improvement Organization (QIO). The new standard would apply to: ambulatory surgical centers (ASCs); hospices; hospitals; long term care (LTC) facilities; home health agencies (HHAs); … Continue Reading

MedPAC to Examine Medicare Provider Payment Adequacy (Jan. 13-14)

On January 13 and 14, 2011, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss Medicare payment adequacy for a number of Medicare providers, including: physicians and other health professionals, ambulatory surgical centers, hospital inpatient and outpatient services, outpatient dialysis providers, home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, … Continue Reading

Improper Billing of ASC Services for SNF Residents

The OIG has issued a report entitled “Payments for Ambulatory Surgical Center Services Provided to Beneficiaries in Skilled Nursing Facility Stays Covered Under Medicare Part A in Calendar Years 2006 through 2008.” Based on a sample review, the OIG estimates that Medicare contractors made at least $6.6 million in overpayments to ambulatory surgical centers (ASCs) for services … Continue Reading

MedPAC Meeting on Medicare Payment Adequacy (Dec. 2-3)

On December 2-3, 2010, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss the adequacy of Medicare payment for a variety of services, including hospital (inpatient and outpatient), physician, ambulatory surgical center, outpatient dialysis, hospice, skilled nursing facility, home health, inpatient rehabilitation facility, and long-term care hospital services… Continue Reading

CMS Issues Final CY 2011 HOPPS/ASC Rates

On November 24, 2010, the Centers for Medicare & Medicaid Services (CMS) is publishing its final rule updating the Medicare hospital outpatient prospective payment system (HOPPS) and the ambulatory surgical center (ASC) payment system rates and policies for calendar year (CY) 2011.  Highlights of the lengthy rule are available after the jump.… Continue Reading

CMS Call on ASC Value-Based Purchasing (Oct. 14, 2010)

On October 14, 2010, CMS is hosting a Special Open Door Forum on its ACA-mandated report to Congress on Ambulatory Surgery Center (ASC) Value Based Purchasing. The purpose of the call is to receive comments from ASCs, hospitals, physicians, physician associations, consumer groups, and others interested in the development of CMS’s plan for implementing value-based … Continue Reading

Comment Opportunity on Expanded HHS Plan to Prevent Healthcare-Associated Infections

The HHS Office of Healthcare Quality is soliciting public comments on new draft components of the “HHS Action Plan to Prevent Healthcare-Associated Infections.” Specifically, HHS seeks comments on its draft strategies to prevent and reduce healthcare-associated infections in ambulatory surgical centers and in end-stage renal disease facilities, along with a draft strategy to increase influenza vaccination … Continue Reading

CMS Proposes CY 2011 HOPPS/ASC Rates, Revises 2010 Rates

On July 2, 2010, CMS released its proposed rule updating the Medicare hospital outpatient prospective payment system (HOPPS) and the ambulatory surgical center (ASC) payment system rates and policies for calendar year (CY) 2011. The official version of the rule is scheduled to be published in the Federal Register on August 3, 2010. Comments on … Continue Reading

CMS Clarifies ASC Waiting Area Requirements

On May 21, 2010, CMS issued guidance to state survey agencies clarifying CMS requirements for ambulatory surgical center (ASC) waiting areas, including the prohibition on the sharing of waiting areas with other entities. The guidance also discusses opportunities for existing ASCs that have waiting areas shared with other entities to obtain waivers as part of … Continue Reading

CMS Proposed Rule on ASC Condition of Coverage/Patients’ Rights

On April 23, 2010, CMS published a proposed rule that would revise the Medicare ambulatory surgical center (ASC) patients rights condition for coverage (CfC) that currently requires certain patient’s rights information to be provided to patients in advance of the date of the procedure. CMS observes that the current requirement has been problematic for ASCs that … Continue Reading
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