REGULATORY REVIEW


Medicare’s 2015 Final Payment Rule Policy changes that impact your ASC BY KARA NEWBURY


The Centers for Medi- care & Medicaid Services (CMS) issued its final payment rule regulating 2015 ASC Medicare pay-


ments on October 31, 2014. Provisions in the rule—effective January 1, 2015, unless otherwise specified—gov- ern ASC payment rates, which proce- dures ASCs may perform on Medicare patients, the ASC Quality Reporting (ASCQR) Program and more. While the rule accommodated sev-


eral requests ASCA has advocated for on behalf of the industry, disparate payment policies for hospital outpa- tient departments (HOPDs) and ASCs continue to negatively impact ASCs.


CPI-U vs Hospital Market Basket CMS finalized an effective payment update of 1.4 percent for ASCs and an effective payment update of 2.2 per- cent for HOPDs in 2015.


The disparity in updates is due in


large part to the different update fac- tors used for each site of service. Facility fees for HOPDs are updated annually based on the hospital market basket, which measures the inflation of medical costs such as equipment, sup- plies and staffing. ASC facility fees are updated based on the Consumer Price Index for all Urban Consumers (CPI-U), which measures the cost of consumer goods such as bread, milk and gasoline and is historically lower than the hospital market basket. As in previous years, prior to release of the final rule, ASCA asked CMS to use the hospital market basket to update ASCs as well to align the two update factors and prevent a continuing divergence in payment rates. As a reminder, the rates that CMS released do not take into consider- ation sequestration, a 2 percent cut


in Medicare provider payments that was included in the Budget Control Act signed into law in August 2011. Sequestration reduces only the portion Medicare pays providers by 2 per- cent; the patient responsibility is not impacted by sequestration.


Procedure List


As a direct result of a presentation given by an ASCA member surgeon and administrator last year, CMS final-


Track the Latest Regulatory and Legislative News for ASCs


Visit ASCA’s web site every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs.


www.ascassociation.org/ GovtAffairsUpdate


ized the addition of the following 11 spine codes to the ASC list of payable procedures for 2015, determining that these procedures are safe and effective when performed in the ASC setting. ■


22551 (Neck spine fuse&remov bel c2) ■ 22554 (Neck spine fusion) ■ 22612 (Lumbar spine fusion)


■ 22614 (Spine fusion extra segment) ■ 63020 (Neck spine disk surgery) ■ 63030 (Low back disk surgery) ■ 63042 (Laminotomy single lumbar) ■ 63044 (Laminotomy, additional lumbar) ■ 63045 (Removal of spinal lamina) ■ 63047 (Removal of spinal lamina) ■


63056 (Decompress spinal cord) CMS also


agreed with ASCA’s


assessment that CPT codes 22551, 22554 and 22612 were assigned to the wrong ambulatory payment classifi- cation (APC) group and moved these codes to APC 0425, which has a sig- nificantly higher reimbursement than the group to which these codes were assigned previously, APC 0208. Unfortunately, under the 2015


final rule, 352 codes that Medicare previously designated as payable when they are performed in HOPDs still are not designated as payable in the ASC setting. ASCA will continue to encourage CMS to move these procedures to the ASC payable list, particularly focusing on those codes being performed in high volumes in HOPDs, an indicator that they are safe to be performed on the Medicare population in outpatient settings.


Device-Intensive Policy Change CMS also finalized a significant change to its device-intensive procedure payment policy that will benefit ASCs, changing the definition of device- intensive


procedures to include


any procedure assigned to an APC group with a device cost greater


ASC FOCUS FEBRUARY 2015 21


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