The Centers for Medicare and Medicaid Services issued their final rules on ASC and hospital outpatient payment systems for calendar year 2009, as well as a revision to their ASC conditions of coverage, on Oct. 30. The rules, which take effect Jan. 1, include the following highlights:
For ASCs:
Just as in 2008, Medicare's revised ASC payment system, entering the second year of a four-year transition period to bring it in line with the hospital Outpatient Prospective Payment System, does not provide for an inflation update in calendar year 2009.
Twenty-seven surgical procedures will be added to Medicare's ASC payment list, including 14 previously excluded procedures and 13 new CPT codes. (Eight procedures will be added to Medicare's list of reimbursable office-based procedures.)
Medicare's ASC Conditions for Coverage define the ASC as "a distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following admission." This definition, developed in response to ASC industry feedback, revised an August 2007 proposal that would have ruled out treatment involving an overnight stay, which CMS defines as "requiring active monitoring by qualified medical personnel, regardless of whether it is provided in the ASC, after 11:59 p.m. on the day of admission."
The conditions for coverage also include provisions on patients' rights, the role of ASC governing bodies in quality improvement, infection control, pre-op assessment and emergency planning.
For hospital outpatient departments:
The 2009 final rule on payment rates includes a 3.6 percent annual inflation update.
Hospitals participating in Medicare's Hospital Outpatient Quality Data Reporting Program that fail to meet their requirements for 2009 will see that increase cut by 2 percentage points.
In order to receive the full inflation update in 2010, hospitals must report data on 11 quality measures in calendar year 2009, up from seven in calendar year 2008.
Medicare is considering proposing a healthcare-associated conditions payment policy for hospital outpatient departments similar to its recent rules which ended payment for the treatment of medical errors and preventable complications in inpatient stays.
A new composite APC will provide a single payment when a procedure involves two or more imaging sessions using the same modality.
The final rule will be published in the Nov. 18 Federal Register and comments on selected sections will be accepted until Dec. 29 at 5 p.m. Eastern time.
—David Bernard
