REGULATORY REVIEW
Exempt,” a members-only page avail- able on the Payment Resources section of ASCA’s web site.
Potential Downward Adjustment As a reminder, ASCs must meet all Ambulatory Surgical Center Qual- ity Reporting (ASCQR) Program requirements in order to receive the full ASC annual program update. For more information, visit
www.asc
association.org/federalregulations/ qualityreporting.
Other Payment Methodologies CMS uses different methods to set ASC payment rates for office-based procedures, separately payable radiol- ogy services, separately payable drugs and device-intensive procedures. Office-based procedures are defined as those furnished in physi-
Based on the results of a survey conducted by the US Government Accountability Office, CMS determined that labor accounts for approximately half of an ASC’s costs.”
—Kara Newbury
cians’ offices at least 50 percent of the time. Payment for these procedures is set at the lower of the standard ASC rate or the practice expense portion (this amount covers equipment, sup- plies, non-physician staff and overhead expenses of a service) of the physician fee schedule rate that applies when the service is furnished in a physician’s
office. CMS applies the same policy to separately payable radiology services. When separately payable drugs are
furnished in ASCs, CMS pays ASCs the same amount it pays under the OPPS. Device-intensive procedures are defined as OPPS services for which the device cost is packaged into the procedure payment and the cost of the device accounts for at least 40 percent of the total payment (based on the OPPS payment). CMS divides the payment into a device portion and a non-device portion. CMS pays the ASC the same amount it would under the OPPS for the device portion but pays the lower amount for the non- device portion of the service.
Kara Newbury is ASCA’s regulatory counsel. Write her at
knewbury@ascassociation.org.
20 ASC FOCUS MARCH 2015
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