of device-intensive codes from 154 in 2018 to 264 in 2019 resulted in another shift in volume from the higher-cost HOPD setting to the ASC setting.
Wage Index Application for Device Intensive Codes
Although this has not gotten as much attention as the change in the thresh- old for the device offset, ASCA has been consistently imploring CMS to refrain from adjusting the device por- tion of the payment by the local wage index. This is consistent with the agen- cy’s policy for separately payable drugs and biologics, and it is proba- bly not the case that a facility in a rural community is getting a better deal on devices than other ASCs. One exam- ple of how much the wage index can impact device-intensive codes is for a knee reconstruction code, CPT code 27429. The national rate for 27429 is currently $10,113.69 and CMS esti-
mates the device costs at $8,866.89. In rural Tennessee, where the local wage index is currently 0.7076, the current reimbursement rate for 27429 is $8,635.07, which is less than the device costs. There are currently 27 device-intensive codes for which the device cost exceeds the total reim- bursement rate in rural Tennessee and this issue impacts all communities with a lower wage index.
CELEBRATING 75 YEARS OF EXCELLENCE IN HEALTHCARE ACCREDITATION
HFAP provides:
• Trusted, recognized programs for ASC accreditation with or without Medicare deemed status.
LEARN MORE:
WWW.HFAP.ORG
CONTACT US: 312.920.7383
INFO@HFAP.ORG
• Accreditation for clinical laboratories.
• Certification for Joint Replacement programs and Compounding Pharmaceuticals.
• Responsive, accessible, cost-effective customer support.
Co-Pay Cap As explained in the Advocacy Spotlight department on page 38, there is a co- pay cap for Medicare beneficiaries— currently $1,408—when a procedure is performed in a hospital as either an inpatient or outpatient procedure. What- ever the difference is between what the patient would usually pay (20 percent of the reimbursement rate) minus $1,408, the hospital is made whole by the Medi- care program. While this did not impact ASCs as much in the past, as ASCA promotes better reimbursement poli- cies for ASCs and increases the number of device-intensive codes, which often also have some of the higher reimburse- ment rates in the ASC payment system, this patient co-pay cap available only when these procedures are performed in hospitals becomes a larger issue. In 2020, Medicare beneficiaries would have to pay more out of pocket to have their procedure done in the ASC set- ting for 125 of the 296 device-intensive codes. ASCA is working hard to get this changed legislatively so Medicare and its beneficiaries are not disadvantaged by this oversight in payment policy.
her at
REGULATORY AND LEGISLATIVE NEWS FOR ASCs
to stay up to date on the latest
36 ASC FOCUS OCTOBER 2020 |
ascfocus.org
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