HFMA WEBINAR Final Rule Changes to OPPS and ASCs

Transcription

1 HFMA WEBINAR 2014 Final Rule Changes to OPPS and ASCs Date: December 5, 2013 Time: 2:00 3:30 p.m. Central (12:00 1:30 pm Pacific/1:00 2:30 pm Mountain/3:00 4:30 pm Eastern) Follow this link (or paste it into a browser) to connect: Please log in 10 minutes early and test your computer as this is a new platform: Enter platform where it says guest type in your full name first and last name only it is very important especially if you need CPE credit so that your attendance is accounted for You will Not be using your telephone, but will hear the audio via your computer speaker Online live seminars are broadcast over the web via Adobe Connect. You'll need a computer with a browser, Adobe Flash Player 10.1, and Internet connection. Test your connection to Adobe Connect: Login issues to check first: Are you connected to the Internet? Disable popup blocker software. Clear the browser's cache. Try connecting from another computer. Are you accessing the correct URL? Audio Issues: Close all Microsoft Applications, especially Outlook and Messenger. Having Outlook open absorbs almost 50% of the bandwidth which may cause intermittent audio interruptions. If you have questions regarding registration or connection please call HFMA Member Services at ( , ext 2). CPE Information: To receive CPE Credits for this webinar you must participate in online polling during the webinar and complete the online program evaluation within 2 working days. After 2 working days online programs will be inactive and you will not receive CPE Credit. The URL below will take you to our on-line evaluation form. You will need to enter your HFMA I.D. # (found in your confirmation ) You will also need to enter this Meeting Code: 13AT55 URL: You may also connect directly from the last slide of the live webinar Your comments are very important and enable us to bring you the highest quality Programs! To review your CPE information, please visit the HFMA web site at log into your profile, and retrieve all CPE information (by date) within your "CPE Center.

2 2014 Final Rule Changes to the Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgery Payment System December 5, :00 3:30 p.m. Central (12:00 1:30 pm Pacific/1:00 2:30, pm Mountain/3:00 4:30 pm Eastern) Presented by: Mike Kovar Principal WeiserMazars LLP Ellicott City, MD About the Presenter Mike Kovar is an Maryland based Principal in the Health Care Advisory Services Practice of WeiserMazars LLP. He has over 25 years of experience in the health care industry focusing in the hospital provider areas. Mike has both operations and consulting experience focusing primarily in the regulatory, billing/coding, and compliance areas. Mike presents for HFMA nationally on a number of different revenue related topics including HFMA s Charge Master Essentials and Achieving Revenue Improvements through Charge Master & Charge Capture classes. 2

3 Learning Objectives for Today You will learn: The impact of the final rule on hospital outpatient services and ambulatory surgery centers Key issues to consider What action steps you should initiate Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Payment System (ASC) Final Rule Display copy issued on November 27, 2013 Scheduled to be published in Federal Register on December 10, 2013 Rule is effective January 1, 2014 except for certain non-opps provisions of the Rule such as the EHR incentive program, Organ acquisition, etc. Effective 60 days from Federal Register rule publication 4

4 Overall Impact of 2014 OPPS Changes 1.8% increase in Medicare payments in 2014 to all hospitals including cancer and children s hospitals and CMHCs Estimated payments approximate $50.4 billion $4.4 billion increase over Overall Impact of 2014 OPPS Changes Impacts on different hospital categories are as follows: urban hospitals 2.0% rural hospitals 1.1% sole community rural hospitals 1.6% urban hospitals beds 1.6% major teaching hospitals 1.4% non-teaching hospitals 1.8% governmental hospitals 1.1% proprietary hospitals 2.0% CMHCs 1.8% 6

5 Overall Impact of 2014 OPPS Changes (cont d) Impact on most provider categories gravitates to the 1.8% overall increase Total beneficiary liability for copayments would increase as an overall percentage of total payments 21.6% in 2014 versus 20.4% in Overall Impact of 2014 OPPS Changes (cont d) CMS has a publicly available file to estimate the impact of the 2014 final OPPS rule on it s website for every OPPS hospital OPPS NPRM Facility-Specific Impacts Payment/HospitalOutpatientPPS/index.html Provider CBSA Number Code Total Discounted Units Rural Sole Community and Post Urban/Rural Essential Access Reclassification Geographic Hospitals Wage Index All Rural Location Region Disproportionate Outpatient Estimated 2014 Share Patient Cost-to- Estimated 2013 Estimated 2014 Outlier Number of Teaching Percentage Charge Ratio OPPS payment OPPS payment Payment Beds Hospitals Ownership CMHC Provider Lines , OURBAN ESC 29.9% $38,555, $40,409, $52, NONE 3 N 384, , RURAL ESC 33.0% $19,934, $19,996, $ NONE 3 N 285, , OURBAN ESC 25.2% $17,183, $17,223, $56, NONE 2 N 226, , RURAL ESC 18.3% $1,588, $1,490, $13, NONE 3 N 58,117 8

6 Overall Impact of 2014 OPPS Changes (cont d) Top 10 CPT Code Winners-2014 Versus 2013 HCPCS Code Short Descriptor 2014 Payment Rate 2013 Payment Rate 2014 Payment Variance Insrt pulse gen w/dual leads $25, $22, $ 2, Insrt pulse gen w/mult leads $25, $22, $ 2, Insrt pulse gen w/singl lead $25, $22, $ 2, Remv&replc cvd gen sing lead $25, $22, $ 2, Remv&replc cvd gen dual lead $25, $22, $ 2, Remv&replc cvd gen mult lead $25, $22, $ 2, Implant neurostim arrays $23, $20, $ 2, Artery x-rays spine $4, $ 2, $ 2, Artery x-rays abdomen $4, $ 2, $ 2, Shoulder arthroscopy/surgery $4, $ 2, $ 2, Overall Impact of 2014 OPPS Changes (cont d) Top 10 CPT Code Losers-2014 Versus 2013 (Excludes add-on CPT Codes no longer paid) HCPCS 2014 Payment 2013 Payment 2014 Payment Code Short Descriptor Rate Rate Variance Muscle transfers $3, $ 5, $ (2,080.84) Repair shoulder capsule $3, $ 5, $ (2,080.84) Reconstruct elbow lat ligmnt $3, $ 5, $ (2,080.84) Reconstruct elbow med ligmnt $3, $ 5, $ (2,080.84) Revision of humerus $3, $ 5, $ (2,080.84) Revise radius & ulna $3, $ 5, $ (2,080.84) Lengthen radius or ulna $3, $ 5, $ (2,080.84) Repair radius or ulna $3, $ 5, $ (2,080.84) Repair/graft radius or ulna $3, $ 5, $ (2,080.84) Repair/graft wrist bone $3, $ 5, $ (2,080.84) Fusion radioulnar jnt/ulna $3, $ 5, $ (2,080.84) Repair of knee ligaments $3, $ 5, $ (2,080.84) Repair/graft achilles tendon $3, $ 5, $ (2,080.84) Ankle arthroscopy/surgery $3, $ 5, $ (2,080.84) 0071T U/s leiomyomata ablate <200 $1, $ 3, $ (2,052.36) 10

7 Summary of Final 2014 Rule Updates affecting OPPS payments including: New Packaging Policies for 2014 OPPS APC group policy changes Payment changes for devices Payment changes for drugs, biologicals, and radiopharmaceuticals OPPS Transitional pass-through spending estimates for drugs, biologicals, radiopharmaceuticals and devices Payment changes for visits 11 Summary of Final Rule (cont d) Payment changes for partial hospitalization services Inpatient only procedure additions Nonrecurring Policy Changes Supervision of outpatient therapeutic services Application of Therapy Caps in CAHs Requirements for payment of Outpatient Therapeutic Hospital or CAH services OPPS payment status changes and comment indicators Update of the Ambulatory Surgery Center (ASC) payment system 12

8 Summary of Final Rule (cont d) Hospital outpatient quality reporting program updates ASC quality reporting requirements The following parts of the rule will not be covered today: Hospital Value-Based Purchasing Program Update Conditions for Coverage related to Organ Procurement Organizations Revisions of the Quality Improvement Organization (QIO) regulations Medicare Fee-for-service Electronic Health Record (EHR) Incentive Program Final Rule Provider Reimbursement Determinations and Appeals Final Rule 13 OPPS Background Outpatient Prospective Payment System (OPPS) was first implemented on August 1, 2000 Medicare pays for hospital outpatient services on a rate-per-service basis that varies based on the ambulatory payment classification (APC) assigned to the service Healthcare Common Procedure Coding System (HCPCS) is used to identify and group services in an APC HCPCS includes both CPT and HCPCS Level II Codes Payment is based on status indicators (See Addendum D1) All services within an APC are comparable clinically and relative to resource use. Service are not considered comparable relative to resource use if the highest mean cost for an item or service in an APC is more than 2 times greater than the lowest mean cost of an item or service in the same APC. 14

9 OPPS Background Hospitals excluded from OPPS: Maryland hospitals for services paid under the cost containment waiver Critical access hospitals Hospitals outside the 50 states, the District of Columbia, and Puerto Rico Indian Health Service hospitals 15 Updates Affecting OPPS Payments Approximately 158 million final action claims for services provided in a hospital outpatient setting from January 1, 2012 through December 31, 2012 were used to calculate the 2014 rates Single/ pseudo claims process used in previous years again used for 2014 rate setting purposes Medicare lists bypassed HCPCS Codes to determine single claims in Addendum N 16

10 Updates Affecting OPPS Payments Hospital-specific overall ancillary and department cost-to-charge ratios (CCRs) used to convert charges to estimated costs through application of a revenue code-to-cost center crosswalk For 2014 Department specific CCR were for the first time used in rate setting for the following cost centers: Implantable Devices Charged to Patients Cardiac Catheterization MRI CT Scan Most recent submitted, in most cases, cost reports beginning in CY 2011 used to calculate CCRs (cost-to-charge ratio) to be used to calculate costs for the CY 2014 OPPS payment rates To calculate APC costs, Medicare calculated hospital specific overall ancillary CCRs and hospital-specific departmental CCRs for each hospital with 2012 claims data 17 Updates Affecting OPPS Payments CMS proposed creation of 29 comprehensive APCs to replace 29 existing device-dependent APCs in the 2014 OPPS Proposed Rule Comprehensive APC defined as a classification for provision of a primary service and all adjunctive services Single payment for all services Encompasses 136 HCPCS Codes Status J1 created for this classification Pacemaker/AICD Insertions, Stent Insertions included in this classification Only excludes services not covered by Medicare Part B or are not payable under OPPS Device dependent edits removed for all APCs 18

11 Updates Affecting OPPS Payments Includes the following: Diagnostic procedures, laboratory tests and other diagnostic tests, and treatments that assist in delivery of the primary procedure; Visits and evaluations associated with the procedure including the following room and board and nursing revenue codes: 012X, 013X, 015X, 0160, 0169, , , 0214, 0219, , 0239, , 0249 This was removed from final rule for implementation in 2015 Uncoded services and supplies used during the service; Outpatient services delivered by therapists; 19 Updates Affecting OPPS Payments Includes the following: DME as well as prosthetic and orthotic items and supplies; and Any other components reported with HCPCS Codes provided during the comprehensive service except mammography and ambulance services All drugs including self-administered drugs excluding pass-through drugs (Status Indicator G) and brachytherapy seeds Implementation of this policy change is delayed until CY 2015 except for removal of the device-dependent edit process 20

12 Updates Affecting OPPS Payments For CY 2015, when more than one J1 procedure is performed in the same encounter, the APC will be reassigned to account for higher severity. This only applies to specific combinations of HCPCS Codes This list will be revised prior to implementation in 2015 The list is on the succeeding pages-but will not be implemented in 2014 Comments requested on comprehensive APCs by CMS including individual APC assignments 21 Updates Affecting OPPS Payments 22

13 Updates Affecting OPPS Payments 23 Updates Affecting OPPS Payments 24

14 Updates Affecting OPPS Payments 25 Updates Affecting OPPS Payments 26

15 Updates Affecting OPPS Payments 27 Updates Affecting OPPS Payments 28

16 Updates Affecting OPPS Payments 29 Updates Affecting OPPS Payments 30

17 Updates Affecting OPPS Payments 31 Updates Affecting OPPS Payments 32

18 Updates Affecting OPPS Payments 33 Updates Affecting OPPS Payments Extended Assessment and Management Composite APCs (APCs 8002 and 8003) revised to APC 8009 ($1,199) Now allows any clinic visit (G0463) or along with specific Emergency Room visits or direct admit to observation visits (G0379) furnished in conjunction with observation services to qualify payment This is due to revision of clinic visits levels by CMS Revised criteria for Extended Assessment and Management APC are: No Status Indicator T items on the claim 8 or more units of G0378 CPT Codes 99284, 99285, G0384, 99291, G0379, or G

19 Updates Affecting OPPS Payments For other Composite APCs (Status Indicator Q3), no changes LDR Prostate Brachytherapy (APC 8001) EP Evaluation and Ablation (APCs 085, 8000) Mental Health Services (APC 0034) Multiple Imaging (APCs 8004, 8005, 8006, 8007 and 8008) Cardiac Resynchronization Therapy (APC 0108) 35 Updates Affecting OPPS Payments The following items are packaged conditionally or unconditionally in 2014 (Addendum P): Drugs, biologicals, and radiopharmaceuticals that function as supplies when used in diagnostic tests or procedures Drugs and biologicals when used as supplies in surgical procedures Certain clinical laboratory tests Certain procedures described as add-on codes Device removal procedures 36

20 Updates Affecting OPPS Payments Drugs, biologicals, and radiopharmaceuticals that function as supplies when used in diagnostic tests or procedures will be packaged Stress agents currently paid separately will be packaged into the payment of the nuclear stress tests: J0151 which replaces J0152 Adenosine, 30mg (Adenoscan) in 2014 (Status Indicator K in 2013) J2785 Regadenoson, 0.1mg Status Indicator K in Updates Affecting OPPS Payments Drugs and biologicals that function as supplies when used in surgical procedures will be packaged Skin substitutes ( C or Q codes) packaged for related procedures CPT through used with high cost skin substitutes HCPCS G5271 through G5278 used for low cost skin substitutes CMS to provide quarterly updates of classification of skin substitutes as high versus low cost See list on next page 38

21 Updates Affecting OPPS Payments 39 Updates Affecting OPPS Payments 40

22 Updates Affecting OPPS Payments Laboratory tests provided are integral, ancillary, supportive, dependent, or adjunctive to the primary hospital outpatient services will be packaged (Status Indicator N) Laboratory tests will continued to be paid under the Clinical Laboratory Fee Schedule for the following: Laboratory service is only service provided on that day of service Laboratory service provided on same day of service as primary service ordered for a different purpose than the primary service by a different practitioner than the practitioner providing the primary service Service must be billed with Bill Type 14X on a separate bill Laboratory service provided are molecular pathology tests with CPT codes , , or Updates Affecting OPPS Payments Add-on CPT Codes that are performed in addition to the primary procedure will be packaged + designated CPT Codes Detailed in Appendix D of the CPT Code Manual For example, CPT Debridement extensive eczematous infected tissue; each additional 10% of body surface is now packaged Drug administration add-on CPT Codes will not be packaged 42

23 Updates Affecting OPPS Payments In 2014 Proposed Rule, CMS proposed that ancillary services with Status Indicator X be conditionally packaged This will not be implemented in 2014 with one exception: CPT Cardiac stress test will be conditionally packaged In 2014 Proposed Rule, CMS proposed that diagnostic tests on the bypass list (Addendum P) be conditionally packaged This will not be implemented in Updates Affecting OPPS Payments Device removal procedures will become Status Indicator Q2 Frequently performed with insertion of a new device Packaged if Status Indicator T item is on the claim Clarification on supplies by CMS CMS determined numerous supplies (Level II HCPCS A-codes)billed on OPPS claims that have Status Indicator A and are paid inappropriately under the DMEPOS Fee Schedule Will be changed from Status Indicator A to N 44

24 Updates Affecting OPPS Payments- Other Issues CY 2014 full market basket conversion factor of $ ($ in 2013) and a reduced market basket conversion factor of $ ($ in 2013) for hospitals not meeting the quality reporting requirements. Final FY 2014 IPPS wage indices will be used to calculate CY 2014 OPPS payment rates (see htpp:// Continue policy of a budget neutral 7.1 percent payment adjustment for rural SCHs, including EACHs, for all services and procedures paid under the OPPS, excluding separately payable drugs and biologicals, devices paid under the pass-through payment policy, and items paid at charges reduced to costs. 45 Updates Affecting OPPS Payments- Cancer Hospitals For the 11 designated cancer hospitals in the country, Medicare will adjust each cancer hospital s OPPS payment by the percentage difference between their individual PCR (payment to cost ratio) without TOPs and the weighted average PCR ( target PCR ) of the other hospitals paid under OPPS 2014 target PCR is 0.89 Additional payment at cost report settlement will be the amount needed to result in a target PCR equal to 0.89 for each cancer hospital 46

25 Updates Affecting OPPS Payments- Outlier Payments For hospitals, outlier payments are made that equal 50 percent of the amount by which the cost of furnishing the services exceeds 1.75 times the APC payment when the following thresholds are met: Cost of furnishing the service by the hospital exceeds 1.75 times the APC payment amount; and Exceeds a $2,900 fixed-dollar threshold For example: Total Charges =$7,000; CCR=0.45; APC payment= $1,000 Total Cost of Service=$7,000 X 0.45 = $3,150 Is $3,150 Cost of Service > 1.75 X $1,000 APC Payment= $1,750 YES Is $3,150 Cost of Service > $2,900 Fixed dollar threshold YES Outlier payment = ($3,150-$1,750) X 50% = $700 For CMHCs, if the cost for partial hospitalization under APC 0172 or APC 0173 exceeds 3.4 times the APC 0173 payment, the outlier payment is calculated as 50 percent of the amount by which the cost exceeds 3.4 times the APC 0173 payment rate. 47 Updates Affecting OPPS Payments- Other Issues Calculation of the Adjusted Medicare Payment from the National Unadjusted Medicare Payment Assuming the following: APC 0019=$318.79; Wage index for NY CBSA 35644= Labor adjusted portion of full national adjusted payment= $ (.60 * $ * ) The nonlabor-related portion of the full national unadjusted payment = $ (.40 * $318.79) Total Adjusted Medicare Payment= $ ($ $127.52) National beneficiary copayment cannot exceed 40% of the APC payment in 2014 and cannot be less than 20% of the OPD fee schedule amount Beneficiary copayment collected is limited to the amount of the inpatient deductible. 48

26 Questions 49 OPPS APC Group Policies 50

27 OPPS APC Group Policies 51 OPPS APC Group Policies 52

28 2014 Payment Changes for Devices Pass-through Devices Devices with pass through status eligible for pass through payment for at least 2 years but not more than 3 years Devices no longer eligible for pass through payment are packaged into the cost of the procedure As of January 1, 2014, there are no devices eligible for pass-through payment Device-dependent edits removed as of January 1, 2014 For replaced devices that there is at least 50% credit Credit amount reported in the amount field for Value Code FD FC and FB modifiers no longer required Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals For drugs and biologicals, pass-through payment is the amount by which the drug or biological exceeds the portion of the otherwise applicable Medicare OPD fee schedule that is determined to be associated with the drug or biological (SI=G) Due to the postponement of the Part B drug Competitive Acquisition Program, CMS pays the rate paid in the physician's office setting for all drugs and biologicals with pass-through status ASP + 6% 54

29 2014 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals 14 drugs with pass-through status ending December 31, Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals 26 drugs/biologicals have pass-through status (SI=G) in

30 2014 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals Currently one diagnostic radiopharmaceutical with passthrough payment C1204 Technetium Tc 99m tilmanocept, diagnostic, up to 0.5 millicuries Pass-through status granted October 1, 2013 CMS will no longer require FB modifier for diagnostic radiopharmaceuticals received at no cost or full credit Rarely has occurred No reduction in payment Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals $90 per day cost threshold for separate payment (SI=K) of non-pass through drugs with payment at ASP+6% Packaging determinations will be made on a drug-specific basis rather than a HCPCS Code-specific basis for those HCPCS codes that describe the same drug or biological but different doses Non-pass-through therapeutic radiopharmaceuticals (per day cost of $90) payment is ASP + 6% Nuclear medicine procedure-to-radiolabeled product edits will no longer be used in 2014 Blood clotting factors under OPPS to be paid at ASP+6% 58

31 Other 2014 OPPS Payment and Coding Changes Hospital coding and payment for visits The following current 2013 coding structures for visits is in place: Hospital outpatient clinics CPT Codes through Type A emergency visits-cpt Type B emergency visits HCPCS Codes G0380-G0384 Visit coding structure revised in 2014: Hospital outpatient clinics HCPCS Code G0463 Single HCPCS Code-APC 0634 ($88.31) Reduce administrative burden No need to distinguish new versus established patient or acuity level 59 Other 2014 OPPS Payment and Coding Changes Hospital coding and payment for visits Visit coding structure revised in 2014: Type A emergency visits-cpt No change in levels remain Type B emergency visits HCPCS Codes G0380-G0384 No change in levels remain CMS has indicated that they may revisit the emergency visit issue in the future For critical care CPT Code 99291, current policy continues in 2014 that conditionally packages ancillary services reported on same day as the critical care services 60

32 Other 2014 OPPS Payment and Coding Changes 61 Partial Hospitalization Other 2014 OPPS Payment and Coding Changes Payment based on type of provider and number of services 62

33 Other 2014 OPPS Payment and Coding Changes Inpatient only list is detailed in Addendum E Nonrecurring Policy Changes Non-enforcement of therapeutic supervision requirement policy for CAHs and rural hospitals with 100 or fewer beds will expire Require direct supervision unless service is on the list of services that may be furnished under general supervision or is designated as nonsurgical extended duration therapeutic service Clarification of supervision requirements for observation services provided If supervising physician determines and documents in the medical record that the patient is stable and may be transitioned to general supervision, general supervision may be provided for the duration of the service No requirement for periodic initiation of direct supervision 64

34 2014 Nonrecurring Policy Changes Outpatient therapy services furnished by a CAH are subject to the therapy caps in 2014 There is one therapy cap for OT and one therapy cap for PT and SLP combined Codification of the provision that Medicare Part B pays for therapeutic hospital and CAH services and supplies furnished incident to a physician or non-physician practitioner in accordance with.applicable state laws Provides basis for Medicare payment denial if state laws are not followed 65 OPPS Payment Status and Comment Indicators Addendum B of the Federal Register is your "guide" Pay attention to items with the following status indicators changes: All laboratory procedures except molecular pathology procedures will be changed from A to N X"-This status indicator will not be deleted as proposed for 2014 Complete list of 2014 status indicators are listed in Addendum D1 66

35 OPPS Payment Status and Comment Indicators Addendum B of the Federal Register is your "guide" Pay attention to items with the following comment indicators: "CH"-Active HCPCS code with change in status indicator or APC assignment or active HCPCS code that is being discontinued. "NI"-New code for 2014 or existing code with substantial change in 2014 with code descriptor or APC assignment 67 Questions 68

36 Overall Impact of 2014 ASC Changes Overall 1% increase in Medicare payments to ASCs Eye and ocular adnexa 1% Digestive system 5% Nervous system -3% Musculoskeletal system 0% Respiratory system 14% Genitourinary system 3% Cardiovascular 1% Integumentary 4% Auditory 3% Hematologic & lymphatic systems 9% 69 Impact of 2014 ASC Changes on High Frequency CPT Codes For the top 5 frequency CPT Codes, the impact is as follows: CPT Code ($1.1 billion in charges) Cataract 0% CPT Code Upper GI Endoscopy, Biopsy ($163 million) 6% CPT Code Colonoscopy, Biopsy ($154 million) 5% CPT Code Lesion Removal Colonoscopy($97 million) 5% CPT Code Cataract, complex ($88 million) 0% 70

37 ASC Payment System Background CMS implemented a revised ASC payment system in 2008 Policy established to ensure that procedures performed in an ASC Not expected to pose a significant risk to beneficiary safety Not expected to require active medical monitoring Do not last past midnight following the procedure ASC payment policies for covered surgical procedures, drugs, biologicals and certain other covered ancillary procedures are based on OPPS payment policies 71 ASC Payment System Background Addendum DD ASC Payment Indicators A2-Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. D5-Deleted/discontinued code; no payment made. F4-"Corneal tissue acquisition, hepatitis B vaccine; paid at reasonable cost." G2-Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. H2-Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate. J7-OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractorpriced. 72

38 ASC Payment System Background J8-Device-intensive procedure; paid at adjusted rate. K2- Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate. K7 -Unclassified drugs and biologicals; payment contractor-priced. L1- Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made. L6-New Technology Intraocular Lens (NTIOL); special payment. N1-Packaged service/item; no separate payment made. P2 -Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. 73 ASC Payment System Background P3-Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. R2- Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. Z2-Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. Z3-Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs. 74

39 2014 Update of the ASC Payment System 4 procedures add to ASC covered list Update of the ASC Payment System 3 procedures newly added to permanent Office-based designation 76

40 2014 Update of the ASC Payment System Update of the ASC Payment System 78

41 2014 Update of the ASC Payment System Services/items packaged as ancillary or adjunctive under OPPS will also be packaged under ASC Drugs, biologicals, and radiopharmaceuticals that function as supplies when used in surgical procedures; Clinical laboratory tests; Procedures described by add-on codes; Device removal procedures Update of the ASC Payment System (cont d) Comment indicators in Addendum AA and BB are important Pay attention, in particular, to the following comment indicators: "CH"-Active HCPCS code with change in status indicator or ASC assignment or active HCPCS code that is being discontinued. "NI"-New code for 2014 or existing code with substantial change in 2014 with code descriptor or ASC assignment 80

42 2014 Update of the ASC Payment System (cont d) Adjustment to the CY 2013 ASC conversion factor ($42.917) by the wage adjustment for budget neutrality of and the MFP(multi-factor productivity)-adjusted update factor of 1.2 percent, which results in a CY 2014 ASC conversion factor of $ For ASCs not meeting the quality reporting requirements, adjustment to the CY 2013 ASC conversion factor ($42.917) by the wage adjustment for budget neutrality of and the quality reporting/mfp(multi-factor productivity)-adjusted update factor of -0.8 percent, which results in a CY 2014 ASC reduced conversion factor of $ Hospital Outpatient Quality Reporting Program Updates Continue the 2.0 percent reduction in annual payment for hospitals that fail to meet the reporting requirements. 82

43 Hospital Outpatient Quality Reporting Program Updates 83 Hospital Outpatient Quality Reporting Program Updates CMS is removing two Quality Reporting Measures in

44 Hospital Outpatient Quality Reporting Program Updates 85 Hospital Outpatient Quality Reporting Program Updates 86

45 2014 ASC Quality Reporting Program Update ASC Quality Reporting Program Update 88

46 2014 ASC Quality Reporting Program Update 89 Questions 90

47 Thank You Mike Kovar (410) BAL To Complete the Program Evaluation The URL below will take you to HFMA on-line evaluation form. You will need to enter your member I.D. # (can be found in your confirmation when you registered) Enter this Meeting Code: 13AT55 URL: Your comments are very important and enables us to bring you the highest quality programs! 92