August 17, 2010

Changes to Fingerprinting Regulations

Ambulatory Surgical Centers have received a great deal of information recently about the Agency for Healthcare Administration’s implementation of the electronic fingerprinting requirements imposed by House Bill 7069 which passed during the 2010 legislative session. 

The bill affects a large number of health care providers in various ways.  Many ASCs and even AHCA inspection teams are not clear how the bill applies specifically to ASCs. 

Highlights of the ASCs requirements are:

• Effective August 1, Ambulatory Surgical Centers must utilize an electronic fingerprinting vendor instead of mailing fingerprint cards to AHCA;
• The covered employees of the surgery center who must have background screening every five years continue to be the licensee (if not a corporation), the administrator and the chief financial officer;
• If a surgery center is making a new hire of one of these covered employees and that person has not had Level II background screening in the past five years, the employee cannot start in their position until the results of the fingerprint screening are finalized and the employee is cleared by AHCA; 
• if screening of an existing covered employee is greater than five years, the employee must be rescreened prior to licensure renewal.

More information can be found directly on the AHCA Website page on Background screening.  This website is located at http://ahca.myflorida.com/MCHQ/Long_Term_Care/Background_Screening/index.shtml

AHCA is rewriting the rules governing fingerprinting in 59A-35.  When this rule is finalized it will be distributed to ASCs to provide clear guidance on the new reporting requirements.

If you are experiencing difficulty with state inspectors regarding the new fingerprinting requirements, please contact us at 850/222-3000.
 

August 4, 2010

 

AHCA Revising Inspections for H&P

 

The Agency for Healthcare Administration (AHCA) has contacted the Centers for Medicare and Medicaid Services (CMS) for clarification of the Conditions for Patient Assessment and Discharge found in the Medicare Conditions for Coverage 416.52(a). 
 

 

As a result of their discussion with CMS, AHCA has changed, effective immediately, the way that they will survey for pre-operative history and physicals (H&Ps).  An H&P will now be viewed as compliant with the "30 days before the date of the scheduled surgery" found in 416.52(a) if it is performed on the day of surgery so long as it is comprehensive and is reviewed by the surgeon when the latter is pre-operatively assessing the risk of the procedure and anesthesia for the patient. 
 

 

CMS is also expected to provide information to clarify that a comprehensive H&P on the day of surgery meets Standard 416.52(a).
 

 

FSASC credits its members and Board members who made comments either directly or as part of AHCA's presentation at our Annual Meeting, July 22nd for convincing AHCA to confirm the interpretation of the survey Standard with CMS.  We will notify the membership when CMS issues its guidance.

CMS Releases 2011 Medicare ASC Rule

 

CMS recently released its proposed 2011 Medicare ASC rule. The following is a brief analysis from Marian Lowe of the ASC Advocacy Committee. More to come in the near future.

 

On July 2^nd, the Centers for Medicare and Medicaid Services released the CY 2011 proposed payment rule for hospital outpatient departments and ambulatory surgery centers. 2011 marks the end of the transition to the revised ASC payment system: this will be the first year in which payments to ASCs will be based solely on the basis of the outpatient prospective payment system (OPPS) relative weights. After taking into account the scheduled increase in the update factor and decrease resulting from the productivity adjustment, the result will be a zero percent increase in ASC payments next year.  

 

The rule, CMS-1504-P is linked below. 

 

As you know, CMS has used the Consumer Price Index for all Urban Consumers (CPI-U) to update ASC payments since the payment system was originally implemented. Although MedPAC took a significant step forward this year in declaring the CPI-U an inaccurate index for updating ASC payments, we are disappointed that CMS did not propose to replace the CPI-U with the hospital Market Basket for purposes of updating ASC payments, a change which would provide a positive update for ASC payments consistent with MedPAC's recommendation. We have made significant strides in urging the agency to move in that direction and will continue to do so this summer by advancing the issue in the Senate with the help of Senators Wyden and Crapo.

 

There are several important issues in the rule that we will be evaluating as we review the proposal in detail. In the interim, below is a brief recap of a few key issues. 

1. Inflation Update: CMS estimates the CPI-U for 2011 will be 1.6 percent. The hospital market basket is projected to be 2.4 percent, but the reform bill requires it to be reduced by 0.25 percent, leaving the HOPD update at 2.15 percent.
2. Productivity Adjustment: As required by the health reform bill, ASC rates will be reduced by a measure of economy-wide productivity gains (a 10-year rolling average calculated the Bureau of Labor Statistics). CMS estimates this adjustment will be 1.6 percent in 2011, meaning the ASC update will effectively be zero percent. This is inconsistent with MedPAC’s recommended update of 0.6 percent and an outcome we will vigorously protest.
3. Conversion Factor: After taking into account the update and productivity adjustments, CMS further adjusts the conversion factor to account for budget neutrality in the recalibration of the wage index. This recalibration is slightly positive, so the ASC conversion factor for 2011 will rise from the CY 2010 ASC conversion factor of $41.873 to $41.898 for CY 2011.
4. Scaling of ASC Relative Weights: Each year, CMS applies a ‘secondary’ budget neutrality calculation to the ASC relative weights to ensure that changes to the APC relative weights under the OPPS do not result in an aggregate increase or decrease in payments. CMS estimates the scaling factor for 2011 to be 0.9090 (the final CY 2010 scaler was 0.9567). The significantly higher scaler is partly due to the fact that these are the fully transitioned weights and partly due to increases in the OPPS relative weights for ASC procedures.
5. Wage Index: CMS continues to use the pre-floor, pre-reclassified wage index to adjust ASC payments for geographic differences in the relative cost of labor. The differences in some markets starting in 2011 will be particularly pronounced because of a policy in the health reform bill that sets the hospital wage index for inpatient and outpatient services in so-called “frontier states” at 1.0. The states affected by the frontier wage index policy include Montana, Wyoming, North Dakota, South Dakota, and Nevada.
6. Quality Reporting: CMS has had authority since 2008 to implement a quality reporting system for ASCs and reduce payments to providers who do not report quality data to the agency. The industry has developed quality measures that have been endorsed by the National Quality Forum. We have also urged the agency to create an infrastructure for ASCs to report quality data and demonstrate their superior performance on these metrics. Once again, the agency has declined to establish such as system. CMS will, however, be developing a report to the Congress as directed by the reform bill articulating a path toward implementing value-based purchasing in ASCs. We expect the agency to provide more detail on their plans for quality reporting in this document.
7. Waiver of Beneficiary Cost-sharing for Certain Services: The health reform bill waives the deductible and coinsurance for certain preventive services that are paid under the ASC payment system and have been recommended by the United States Preventive Services Task Force with a grade of A or B for any indication or population. This will affect several HCPCS codes for colonoscopies. 

Supporting Documents: 4-CMS-1504-P

June 25, 2010

 

Workers’ Compensation Billing Form Changes Effective July 8th

 

On July 8^th all ASCs must begin to file claims on the UB-04 form. This change is the final stage in the implementation of the Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule- 69L-7.602 (for purposes of this Notice, the “Rule”) which became effective as of January 12, 2010. A copy of the Rule is attached. It is highly recommended that in addition to reading this Notice, the Rule is read in its entirety.

 

The following sections deserve special notice:

 

69L-7.602 Section (4)(a)5

This section of the Rule requires that a claim form shall be “coded … at the highest level of specificity” prior to being “submitted to the insurer, service company/TPA or entity acting on behalf of the insurer…” (for purposes of this Notice, in the aggregate, “Carriers”). There is no further guidance provided in the Rule, with respect to how the Carriers are to determine whether this coding standard has been met. Thus, there may be instances where one or more Carriers apply their own subjective determinations of submitted claims. ASCs are advised to code and report as specific diagnosis and treatment codes as possible in order to avoid claim disallowances and/or adjustments, including denials. 

 

FSASC reminds its members that if there is a belief that the Carriers’ have inappropriately adjudicated submitted Claims for any reason, there are only thirty (30) days from the date of the receipt of an EOB to file an appeal to the Division of Workers’ Compensation. Historically, over ninety-five percent (95%) of appeals are won by providers. For appeal forms and instructions, visit the Florida Division of Workers’ Compensation website at www.myfloridacfo.com/WC.   

 

69L-7.602 Section (4)(a)10

This section of the Rule requires that the reporting of multiple services rendered for each patient on the same date of service be billed on a contiguous claim. This applies to ASCs even if there is more than a single surgeon/attending physician per patient, per date of service; or more than one site within the ASC licenses space from which ASC services are rendered per patient, per date of service, as identified in the patient’s ASC medical record. 

 

FSASC expects that this requirement will cause ASCs to have to manually generate a claim when multiple services are rendered, as most software systems cannot automatically generate claims to meet the requirement. FSASC members are encouraged to discuss this issue with their software provider.

 

7.602 Section (4)(b)6.b.

This section requires that ASCs convert from the current Form DFS-F5-DWC-9, which is the CMS 1500 form, to the Form DFS-F5-DWC-90, which is the UB-04 form. FSASC has worked extensively with the Division of Workers’ Compensation in order to adapt the full UB-04 form and instructions to standard ASC operating procedures. The instructions for the Form DFS-F5-DWC-90 should be read carefully. They are attached to this notice.

 

Notwithstanding this reference to use HCPCS required in this section for general billing, the section also instructs that “ASCs shall use ... workers’ compensation unique code(s) with required modifier(s) pursuant to Rule 69L-7.100, F.A.C., when billing for surgical implants, associated disposable instrumentation, and applicable shipping and handling pursuant to Rule 69L-7.100”. The workers’ compensation unique code is 99070 according to the 2006 ASC Workers’ Compensation Reimbursement Manual (rule 69L-7.100).  

 

The wording of this section may be such that it causes carriers to interpret that a HCPCS code should be provided for surgical implants, associated disposable instrumentation and applicable shipping and handling and thus deny this portion of a claim. Should this happen, improperly adjudicated claims may be appealed to the Division of Workers’ Compensation as detailed above.

 

Supporting Documents: 69L-7.602 , Instructions for Completion of DFS F5 DWC 90

https://www.flrules.org/gateway/readFile.asp?sid=0&tid=8140354&type=1&File=69L-7.602.doc