2013 Final Payment Rule
According to Medicare's 2013 final payment rule, ASC payment rates will increase by 0.6 percent in 2013. This increase is based on a projected rate of inflation of 1.4 percent minus a 0.8 percentage point productivity adjustment required by the Affordable Care Act. This payment update is substantially below the 1.3 percent update in the proposed rule, which was based on an inflation rate of 2.2 percent minus a 0.9 percentage point productivity adjustment.
According to the rule, hospital outpatient departments (HOPDs) will receive a 1.8 percent increase, based on a 2.6 percent market basket and a 0.8 percentage point productivity reduction.
“We are extremely disappointed that CMS continues to undervalue ASC reimbursements by using the CPI-U to update ASC payments, a factor that even their own actuaries believe is inappropriate," said ASCA CEO Bill Prentice. "Using different update factors for ASCs and hospital outpatient departments widens the gap between HOPD payments and ASC payments, further incentivizes a disturbing trend of conversions of ASCs to HOPDs and increases costs to the Medicare program, it’s beneficiaries and taxpayers who support the program."
ASCA’s Medicare Resources
ASCA provides members information and resources designed to help them navigate the increasingly complex world of Medicare.
In order to be paid by Medicare, ASCs must enter into an agreement with Medicare and meet its certification requirements, known as the Conditions for Coverage. Additionally, some states and private payers require that ASCs meet Medicare’s Conditions for Coverage.
These requirements are comprehensive and cover every aspect of an ASC, from facility design to patient care. ASCA’s member-only certification page provides ASC operators all the information they need to make the potentially daunting Medicare certification process easy.
Medicare also produces “Interpretive Guidelines” for the Conditions for Coverage. In addition to reiterating the text of the Conditions for Coverage, this document provides guidance on the meaning of the rules and further advice on how ASCs should comply.
In addition, Medicare requires ASCs to comply with the 2000 edition of the Life Safety Code, updated and published by the National Fire Protection Association.
In 2008, CMS implemented a significantly revised payment methodology based on the Ambulatory Payment Classification systems used in HOPDs. This members-only page provides detailed information about how the ASC payment system works and resources to help ensure that your ASC is being paid correctly.
CMS requires ASCs to report data on quality measures beginning in 2012. ASCs that fail to report will face reductions in their Medicare payment rates in future years. ASCA members can learn more about the quality proposal on the Quality Reporting page and access resources to help them prepare for 2012, including a Quality Reporting FAQs page.
2013 and Future Measures
Answers to your Medicare questions are just a phone call away! The Member Services Team is a dedicated team of professionals who are available to assist members with Medicare and other issues. Call 703.836.8808 and ask to speak to a membership services team member.