LATEST DEVELOPMENTS FROM HCFA
October 1, 1998
Notice of reopening of comment period of proposed rule and delay in adoption of provisions (Federal Register, October 1, 1998).
The proposed rule affecting Medicare payments to ambulatory surgical centers (ASCs) will be delayed until concurrent adoption of the hospital outpatient prospective payment system (PPS), which is now planned for as early as possible after 1/1/2000. [Federal Register on September 8, 1998 (63 FR 47551)].
ASC Payment rates will remain in effect until adoption of the Medicare hospital PPS with rates set as follows:
Group 1 -$314
Group 2 -$422
Group 3 -$482
Group 4 -$595
Group 5 -$678
Group 6 -$789 ($639+$150 for IOL)
Group 7 -$941
Group 8 -$928 ($778+$150 for IOL)
We encourage you to voice your opinions to HCFA. The comment period has been reopened to 5 p.m. on November 9, 1998. Mail written comments (one original and three copies) to the following address:
Health Care Financing Administration
Department of Health and Human Services
Attention: HCFA-1885-P
P.O. Box 26688
Baltimore, MD 21207-5178
For details on this important development, take advantage of our direct link to the Federal Register.
September 8, 1998
HCFA's Prospective Payment System for Hospital Outpatient Services Delayed Until Y2K
(Federal Register, September 8, 1998)
Although the statutory effective date for the outpatient prospective
payment system is January 1, 1999, implementation of the new system will
have to be delayed because of the year 2000 systems concerns. The
demands on the intermediary bill processing systems and HCFA internal
systems to become compliant for the year 2000 preclude making the major
systems changes that are required to implement the prospective payment
system. The outpatient prospective payment system will be implemented
for all hospitals and community mental health centers as soon as
possible after January 1, 2000, and a notice of the anticipated
implementation date will be published in the Federal Register at least
90 days in advance.
August 10, 1998
HCFA extends comment period for proposed changes to
Ambulatory Surgical Center Service Reimbursement (Federal
Register, August 14, 1998)
Because of the complexity and scope of the proposed rule and because
numerous members of the industry and professional associations have
requested more time to analyze the potential consequences of the rule,
HCFA has decided to extend the comment period for an additional 30 days.
This document announces the extension of the public comment period to
September 10, 1998.
June 12, 1998
HCFA Proposes changes to regulations
for Ambulatory Surgical Center Service Reimbursement (Federal
Register, June 12, 1998)
HCFA recently announced sweeping changes to existing Ambulatory
Surgery Center (ASC) payment regulations. Under this change,
reimbursement would follow Ambulatory Payment Classifications
(APCs), which assign procedures to payment groups based on time,
type of surgery and body system involved.
These proposed reimbursement rates are based on 1994 cost
data submitted by 295 ASCs in response to HCFAs last survey on
ASC facility overhead and procedure specific charges. HCFA officials
have expressed disappointment in their lack of success in gathering
usable resource cost data from the 1994 ASC survey.
Overall, the proposal threatens an ASC's ability to offer
comprehensive, technologically advanced, ambulatory surgical
care to Medicare beneficiaries. Significant and potentially devastating
changes are proposed.
Since the proposed reimbursement rates do not take into consideration
the costs of new minimally invasive surgical technologies introduced
after the 1994 ASC survey, such as new breast biopsy and endometrial
ablation technologies, this proposal could result in denied access
to women seeking these ambulatory procedures at an ASC.
Reimbursement reductions are proposed for many ambulatory
surgical procedures including such high-volume procedures as
cataract surgery, gastrointestinal and urinary tract endoscopies,
and both excisional and incisional breast biopsy.
For more information contact USSC's Health Policy & Reimbursement
Hotline
- (800) 336-0263
