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Recent Legislative Updates Every ASC Leader Should Know

October 17, 2017



Recent-Legislative-Updates-Every-ASC-Leader-Should-Know

The ever transitory clinical practice and healthcare technology advancements allow surgeons to perform more procedures in the outpatient setting. ASCs offer much more convenience than hospital outpatient departments, which includes quick surgical scheduling. Clinical physicians have more autonomy when they are performing cases in an ASC than an HOPD. This allows them the freedom to design customized surgical environments and participate in the specialized staff hiring process. They are also popular because Medicare beneficiary coinsurance is lower in ASCs than HOPDs for many procedures. ASCs today are associating with physical therapists and rehabilitation specialists to make certain that their patients receive the right care after surgery to optimize the treatment outcomes. It is thus believed that ASC can bring down the cost of care while escalating the quality.

CMS has proposed raising the ASC billing payment rate 1.9 percent in 2018. The increase would be based on the consumer price index. This increase would only be granted for centers that meet quality reporting requirements. For ASC quality reporting, CMS plans to make changes in 2019, removing three measures from the reporting list:

  • ASC-5: Prophylactic Intravenous (IV) Antibiotic Timing
  • ASC-6: Safe Surgery Checklist Use
  • ASC-7: Ambulatory Surgical Center Facility Volume Data on Selected Ambulatory Surgical Center Surgical Procedures

 

Here is the comprehensive list of three legislative changes in the healthcare industry that every ASC leader’s needs to acknowledge:

The California 'surprise medical bill' impacting surgery centers

In the year 2016, California Governor Jeffery Brown signed the Assembly Bill 72. This legislation places a vault on the amount that the out-of-network surgeons and other providers can bill the patients for covered non-emergency services that ASCs and other facilities offer. Now onwards under the law, ASCs and other facilities have to bill enrollees the same cost-sharing amount that the enrollee would pay a contracted professional for the service.

CMS cuts out on cardiac bundles, gets rid of CJR model

The bundled payment program used to be mandatory in case of heart attacks and bypass surgeries and the cardiac rehabilitation. The recent changes by CMS proposed a rule that would cancel it. This proposed rule would also eliminate mandatory bundling for hip and femur fracture treatment, proposed under the Comprehensive Care for Joint Replacement program.

Republicans Health care bill defeated for 3rd time

The Republican attempt to pass a "skinny" ACA repeal bill failed after Sens. John McCain, R-Ariz., Lisa Murkowski, R-Alaska, and Susan Collins, R-Maine, voted against it. The "skinny" repeal was estimated to have eliminated the ACA's individual and employer mandates. It would also have temporarily repealed the medical device tax.

 

Category : Best Billing and Coding Practices