ASCA News Digest (January 18, 2017)

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January 18, 2017


ASCA Highlights

Industry News

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    ASCA Highlights

    Renew Your ASCA Membership Today

    Start off 2017 right and renew your ASCA membership to make sure that you and your staff have access to the information and support you need to run your ASC efficiently. Being an ASCA member gives you and your staff access to vital educational resources, timely networking and essential news, information and tools that you can apply daily in your practice. Renew now!

    Note: Not a member? Join ASCA today.
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    Pay just one low price to gain access to ASCA’s entire 2017 webinar series with ASCA's new All-Access Webinars Pass. The series includes both the live events and recordings. Presented by ASC experts, these webinars address significant ASC issues that include top regulatory risks, Quality Assurance and Performance Improvement (QAPI) projects, accreditation survey issues and strategies, peer review, managed care contracting, infection prevention and CPT changes. The cost is $395 for ASCA members and $595 for nonmembers. You save thousands of dollars when you buy the All-Access Pass. Included in your purchase are continuing education credits—AAPC, CEU and AEU—offered with each webinar and the speaker's handouts. Click here to view the full 2017 webinar series and secure your pass.
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    Register for ASCA 2017, May 3–6, in Washington, DC, and make sure everyone in your ASC is prepared for the regulatory, financial and operational challenges you will face this year and beyond. The schedule of more than 60 ASC-specific educational sessions covers topics of interest to administrators, physicians, nurses, business office staff, human resources, materials managers and everyone who works in your ASC. See the full schedule and register. ASCA members receive a discounted rate and can save even more by registering multiple attendees at the same time.
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    The Coverage Your Patients Have—That You Don’t Know About

    Date: Tuesday, January 19th

    Time: 1:00-2:00 pm ET

    Unpaid self-pay balances continue to be a leading source of bad-debt and elevated days in AR for providers, from small providers to the largest health systems. In fact, bad debt in healthcare is projected to rise to $200 Billion by 20191. The good news? There’s active, billable coverage hiding in your “self-pay” accounts.

    Join us to learn how ZirMed Coverage Detection identifies and verifies active insurance coverage that wasn’t known at the time of service—including retroactive coverage your patients may be eligible for—and delivers the information you need to accurately bill payers for the care provided.

    In addition to diving into the state of the industry and the drivers behind hidden and unknown coverage, we’ll detail:

    • Why it costs, on average, twice as much to collect from patients than from payers.
    • How ZirMed Coverage Detection finds 2.8x more billable coverage than competitors’ applications—and delivers, on average, a 10% hit rate.
    • How Coverage Detection helps you enhance patient satisfaction by providing insight into the coverage your patients have or are eligible for.

    Subscribers to the 2016 ASCA Benchmarking program should submit their fourth-quarter (Q4) reports by the end of the month. Reports from the full year will then be posted in mid-February.

    ASCA Benchmarking is an online clinical and operational benchmarking program that provides valuable data about ASCs. These reports can be used to improve outcomes, billing and staffing.

    Not a subscriber? There’s still time to sign up for the 2016 survey. Learn more and purchase a subscription today.
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    ASCA's Director of Government Affairs Heather Ashby is scheduled to speak at the Louisiana Ambulatory Surgery Center Association annual conference on January 20 in Port Allen, Louisiana.

    ASCA's Regulatory Council Kara Newbury is scheduled to speak at the joint Georgia-South Carolina ASC state conference on February 16 in Atlanta, Georgia.

    ASCA's Chief Operating Officer Steven Miller is scheduled to speak at the Texas Ambulatory Surgery Center Society annual conference on March 3 in Austin, Texas.
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    On December 7, 2016, the Office of Inspector General of the US Department of Health & Human Services (HHS) modified certain safe harbors under the Anti-Kickback Statute and modified the associated Civil Monetary Penalty (CMP) rules. ASCs should review the changes in local transportation safe harbor and the update in nominal gift value in particular.

    Local Transportation Safe Harbor:

    The safe harbor allows for free or discounted local transportation if all the following conditions are met:

    • the transportation policy is applied uniformly and consistently;
    • the transportation is not determined in a manner related to the past or anticipated volume or value of federal health care program business;
    • the transportation is not air, luxury or ambulance-level transportation;
    • the transportation is not advertised; and
    • drivers are not paid on a per beneficiary-transported basis.

    “Nominal Value” for Gifts:

    OIG also released a policy statement regarding gifts of nominal value. The policy is in place over the concern that any remuneration is likely to influence the beneficiary’s selection of a particular provider, practitioner or supplier of Medicare or Medicaid payable items or services. Previously, the gift of nominal value exception was no more than $10 per item or $50 in the aggregate per patient in a year. The update is now no more than $15 per item or $75 in the aggregate per patient in a year.
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    Industry News

    UnitedHealth's Surgery Center Play Could Pressure Hospitals on Prices
    Forbes (01/10/17) Japsen, Bruce

    UnitedHealth Group's decision to spend $2.3 billion on a national network of outpatient surgery centers could put pressure on hospitals where surgeries are performed at higher prices. Increasingly, health insurers encourage their enrollees to consider an ambulatory surgery center for a procedure before a hospital.

    One Medical Passport
    Donald Trump's Cabinet Pick Invested in 6 Drug Companies Before Medicare Fight
    Time (01/17) Frizell, Sam

    Donald Trump's nominee to be the country's next health care czar invested last year as much as $90,000 in six pharmaceutical companies shortly before leading a legislative and public relations effort that benefited those specific companies, records show. Within weeks of making investments worth between $1,000 and $15,000 in Eli Lilly, Bristol-Meyers Squibb, Amgen, McKesson, Biogen and Pfizer according to Congressional disclosure forms, Rep. Tom Price co-sponsored legislation and took part in a public effort that ultimately killed proposed regulatory changes that would have likely hurt those companies' bottom lines.

    The Future of Medicine? This Surgery Center Provides Patients a Menu of Options With Set Prices
    Daily Caller (01/14/17) Donachie, Robert

    The key to a well-functioning, cost efficient health care system in the U.S. could very well be on display at an out-patient surgery center in Oklahoma City, Ok. Twenty years ago, after decades of witnessing firsthand a dysfunctional health care system that "is bankrupting the country," Dr. Keith Smith envisioned a self-sustaining, free market oriented health care facility that would operate completely outside the bounds of government control.

    AAFP Again Takes Aim at Outpatient Prospective Payment System
    AAFP News (01/12/17)

    The AAFP recently took advantage of another opportunity to provide CMS with suggestions for improving Medicare's 2017 hospital outpatient prospective payment system and ambulatory surgical center payment system final rule. The final rule( was published in the Nov. 14 Federal Register and left open the option for further comment from stakeholders.

    Duodenoscopes by Fujifilm Medical Systems: Safety Communication - Certain Older Models Removed From Clinical Use
    FDA MedWatch (01/13/17)

    Fuji informed the FDA of its plans to remove legacy 250/450 duodenoscope models from clinical use based on the limited number currently in use. The validated manual reprocessing procedures for the ED-530XT duodenoscope outlined in December 2015 remain the same.

    Will Price-Tags for Medical Procedures Help Consumers? Yes
    Columbus Dispatch (01/09/17) Lawson, Greg

    Imagine shopping for holiday gifts in stores without price tags. Few of us ever eat at those restaurants that don’t put prices on the menu.

    CMS Partners With Commercial and State Insurers to Support Primary Care Practices and Reduce Clinician Burden
    CMS Blog (01/12/17) Conway, Patrick; Lapin, Pauline

    Over the past few years, the Centers for Medicare & Medicaid Services (CMS) has committed to supporting clinicians by providing them with actionable data. This is part of the Administration-wide initiative to unlock government data to promote innovation and best practices.

    Presence Health Settles HIPAA Breach Suit for $475,000
    Healthcare IT News (01/17) Monegain, Bernie

    Presence Health, one of the largest health care networks in Illinois, has agreed to pay a $475,000 fine for failing to report a breach of unsecured protected health information in a timely manner. Officials at the Department of Health and Human Services, Office for Civil Rights, which enforces the Health Insurance Portability and Accountability Act, noted it is the first settlement based on untimely reporting.

    U.S. News & World Report Announces the 2017 Best Jobs
    U.S. News & World Report (01/11/17)

    U.S. News & World Report, the global authority in rankings and consumer advice, today unveiled the 2017 Best Jobs. The new rankings offer a look at the year's best jobs across 15 categories--from best-paying jobs to diverse sectors like business and technology--to help job seekers at every level achieve their career goals.

    Nearly 12 Million People With Medicare Have Saved Over $26 Billion on Prescription Drugs Since 2010
    CMS Press Release (01/13/17)

    The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continue to save on prescription drugs and see improved benefits in 2016 as a result of the Affordable Care Act. More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary – since the enactment of the Affordable Care Act.

    Cigna and Scripps Health Form Alliance to Deliver Innovative Health Plans in San Diego
    Business Wire (01/11/17)

    Scripps Health and Cigna have entered into an alliance to offer employers in and around San Diego integrated health care products designed to improve access, quality and affordability while making the health care experience simpler. Effective April 1, 2017, Scripps and Cigna will jointly offer HMO health plans branded as Scripps Select HMO to employers with at least 100 employees.

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