Tagged with ASC
Five Things for ASC Leaders to Consider with the 2023 CMS Final Rule
The CMS 2023 Medicare Physician Fee Schedule (PFS) Final Rule includes payment rate and procedures updates for physicians’ services paid under this payment schedule. The CMS Final Rule will go effective on January 1, 2023. For ASCs, these changes include increased pay rate for iTind procedures, expanded colorectal cancer screening tests coverage, added new procedures,…
CMS Released the Proposed Outpatient Prospective Payment Rule for 2023
CMS proposed changes to determine payment rates for Medicare services paid under the OPPS and ASC payment system for CY by 2.7%. CMS estimates that total payments to OPPS and ASC providers for CY 2023 will be approximately $86.2B and $5.4B, respectively. Formal comments on the rule are accepted until September 13, 2022.…
CMS Issues Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
CMS has issued a fact sheet detailing existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19.
CMS Provides MIPS Reporting Relief and Extension
CMS is issuing an extension to the 2019 data submission deadline through April 30, 2020. Specifically, the agency is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission.
Ohio Revises Definition of Ambulatory Surgical Facilities
Ohio has released the recently revised definition of an Ambulatory Surgical Facility (ASF), as part of the new 2020/2021 general operating budget legislation. The change expanded the ASF definition, which may require some previously unlicensed facilities to obtain licensure.
CMS, HHS Proposes Changes to Stark Law and Anti-Kickback Statute Reforms
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
UnitedHealthcare Expands Prior Auth Requirements and Site-of-Service Medical Necessity Reviews for Certain Surgeries
UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations.
CMS Advances ‘Patients over Paperwork’ Initiative Under Final Rule
On September 26, CMS issued The Omnibus Burden Reduction (Conditions of Participation) Final Rule, which advances the ‘Patients over Paperwork’ initiative aimed at reducing administrative costs in healthcare.
Texas to Receive Increase in Federal Funds for Uncompensated Care
The Texas Health and Human Services Commission announced, on October 1, that the state will be given $11.6 billion over the next three years to help reimburse health care providers for indigent services and is intended to benefit hospitals, clinics, public ambulance, and dental providers.
House Ways and Means Committee Chairman Proposes New Approach to End Surprise Medical Bills
In a letter to the House Ways and Means Committee, Chairman Richard Neal has proposed that the Departments of Health and Human Services (HHS), the U.S. Labor and Treasury Department, along with other interested parties, consolidate their efforts to develop standards for rates for surprise bills.
Proposed Legislation Aims to Improve Provider Directories Accuracy
Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.
Executive Order Issued to Protect Traditional Medicare and MA Plans
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient Intensity Modulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.
CMS Issues Renewed Guidance to Ensure Medicaid Program Integrity
On June 20, CMS released a renewed guidance to state Medicaid agencies that outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements.
CMS Releases 2018 ACA Risk-Adjustment Data
CMS, on June 28, released its report summary of the Affordable Care Act (ACA) risk adjustment program for the 2018 benefit year. The analysis found that 572 health insurers offering ACA plans participated in the program in 2018, and transfers between the companies totaled $10.4 billion.
CMS Expands Medicare Coverage of Ambulatory Blood Pressure Monitoring
CMS announced, on July 2, that it finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM), extending coverage of blood pressure monitoring devices to all Medicare beneficiaries suspected of reporting abnormal blood pressure levels when administered in clinical settings.
CMS Issues FAQs on BPCI Advanced Model
CMS, on June 21, issued several new or updated frequently asked questions documents on the Bundled Payments for Care Improvement (BPCI) Advanced Model, an Advanced Alternative Payment Model launched last October that will run through 2023.
ICD-10-CM Coding Changes Released for FY 2020
CMS has provided ICD-10-CM coding updates for the fiscal year, starting October 1, 2019 and ending September 30, 2020.
Aetna Issues ASC and Ambulatory Payment Classification (APC) Code Edit Updates
Aetna has released updates regarding how the insurer will handle certain ambulatory surgical center (ASC) and ambulatory payment classification (APC) code edits under the ASC and APC payment methodologies.
CMS Claim Status Category and Claim Status Codes Update
CMS has released updates to the claim status and claim status category codes used for the Accredited Standards Committee, Health Care Claim Status Request and Response and ASC Health Care Claim Acknowledgment transactions.
