In an Aug. 26 webinar hosted by Becker’s ASC Review, National Medical Billing Services President Lisa Rock and NMBS Director of Legislative Research and Advocacy Diana Hilliard, JD, discussed eight of the most pressing legal issues for ambulatory surgery centers.
“The ASC Quality & Access Act is one of the most important pieces of legislation discussed today because it has a direct impact on ASC reimbursement,” said Ms. Hilliard. Currently, Medicare reimbursement rates for hospital outpatient departments are updated each year using the hospital market basket, which is based directly on healthcare costs and inflation. ASC payment is updated based on the Consumer Price Index, which is based on everyday consumer goods. The legislation seeks to change how rate changes are administered and to apply the hospital market basket-based payment adjustments to ASCs.
Under current CMS policy, a screening colonoscopy is completely covered as a preventative service for Medicare beneficiaries. But, if a polyp is found and removed during the procedure, Medicare beneficiaries become subject to cost-sharing. The Removing Barriers to Colorectal Cancer Screening Act seeks to remove cost-sharing in cases of polyp removal.
In 2009, the HITECH Act was enacted to incentivize Medicare providers to adopt and use EHRs. But, ASCs were left out of the equation. The EHR Improvement Act would allow ASC physicians a three-year exemption from the HITECH Act, meaning the cases he or she performs in an ASC would not be taken into consideration when determining meaningful use attestation.
HHS’ Office of Inspector General released a special fraud alert on laboratory payments to referring physicians.”The OIG is concerned that physicians are receiving double payment for these services, which can occur when a physician is paid by a lab and by a third party, such as Medicare,” said Ms. Hilliard.
CMS released the 2015 proposed payment rule for ASCs and HOPDs, which included 10 new spine codes for the ASC payable procedures list.
Sept. 23, 2013, was the deadline to ensure that all business associate agreements are in compliance with HIPAA regulations. All business associates, including subcontractors, must comply with the revised HIPAA omnibus rule. “Also review and ensure that your notice of privacy practice documents have been updated,” said Ms. Hilliard.
There have been several lawsuits involving the EEOC versus a healthcare provider. She recommends proactively accommodating any need of disabled employees, carefully reviewing the Americans with Disabilities Act and consistently documenting all encounters with an employee that could fall under EEOC scrutiny.
The Center for Medicare Advocacy has sued HHS over “rubber stamp” denials, or coverage denials made at the redetermination and reconsideration of levels of appeal. The American Hospital Association also sued HHS over the backlog of Medicare appeals at the third level. The Office of Medicare Appeals and Hearings estimates that the average time for the administrative law judge appeal process has increased to 418 days. Medicare appeals will continue to be a long process of ASCs, but continue to persevere, said Ms. Hilliard.
Download the webinar presentation here.
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Ref. Becker’s Healthcare
This post was first published September 23, 2014 and was updated July 29, 2020.