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Mandatory Quality Reporting Coming for ASCs

Starting next month, ambulatory surgery centers must report 5 measures on Medicare claims.

Published: August 22, 2012

Beginning next month, ambulatory surgical centers must start reporting data on 5 quality measures on their Medicare claims or face future Medicare payment reductions. This new quality reporting program includes 4 adverse events — patient burn, patient fall, wrong site/side/patient/procedure/implant, hospital admission/transfer — and the timing of prophylactic IV antibiotic administration.

This is not a voluntary program. If a facility fails to report the so-called quality data G-codes that Medicare released earlier this year, CMS will reduce the 2014 ASC conversion factor for that center by 2%, causing all of the ASC's Medicare claims to be paid at a lower rate. Failure to report in subsequent years will affect future years' payments to the same extent.

Between Oct. 1 and Dec. 31, 2012, ASCs will be considered successful reporters and not face future financial penalties if at least 50% (this percentage may increase in future years) of their Medicare claims contain quality data G-codes. ASCs should include the G-codes only on claims where Medicare is the primary payor.

Download a free quality reporting toolkit from the Ambulatory Surgery Center Association

Dan O'Connor


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