07/16/2010

CMS Notice on ASC Rates Affected by

CMS Notice on ASC Rates Affected by "Doc Fix"

CMS has released instructions to its contractors to implement the revised rate schedule reflecting the fix to the Medicare physician fee schedule.  The instructions to contractors direct them to implement the revised rate schedule reflecting the 2.2 percent update for services paid between June 1 and November 30, 2010. 

As you know, ASC procedures designated as office-based are paid the lesser of the HOPD or physician office rate.  This will ONLY affect payment for the office-based codes.  The attached schedule from the CMS website reflects the revised rates as well as revisions based on the update for new HCPCS codes added in July. 

CMS has instructed contractors to make the change to their billing system by July 28, but has not directed them to reprocess all ASC claims (since only those with office-based services are affected by the change).  CMS indicates in their notice below that providers should contact their Medicare contractor to get any claims for services between June 1 and July 28 adjusted to reflect the updated rates.

A copy of the email from CMS announcing these changes is below.


Release of thePositive 2.2 Percent Update for the 2010 Medicare Ambulatory Surgical Center Files  

The recent enactment of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, §101, resulted in a positive 2.2 percent update in the 2010 Medicare Physician Fee Schedule (MPFS), effective June 1, 2010, through November 30, 2010.  

Many payment rates under the Ambulatory Surgical Center (ASC) payment system are controlled by payment rate information in the MPFS.  In order to fully comply with this legislation, it is necessary to implement revised MPFS payment rates in the ASC payment system.  Therefore, the Centers for Medicare & Medicaid Services (CMS) has provided its contractors with two sets of positive 2.2 percent ASCFS and ASCPI update files to test, and implement. 

One set of files is for ASC services furnished on or after July 1, 2010, and the second set of files is for ASC services furnished June 1, 2010, through June 30, 2010.  Once installed, Medicarecontractors shall use these updated payment files to process new ASC claims and shall adjust previously processed ASC claims for dates of service on or after June 1, 2010, that are brought to their attention.   

In accordance with the requirements in Change Request (CR) 7008, contractors shall make July 2010 ASCFS fee data for their ASC payment localities available on their websites.  The payment rates in the July 2010 ASCFS fee data files mirror the 2.2 percent update payment rates for services June 1, 2010-June 30, 2010 and also contain payment rates for newly established services identified in CR7008 effective July 1, 2010.   An MLN Matters article which explains the requirements in CR 7008 may be found at: http://www.cms.gov/MLNMattersArticles/downloads/MM7008.pdf   on the CMS website.  

CMS is aware that contractors were unable to implement the revised payment rates by the July 6, 2010 implementation date contained in CR7008 because these files have just become available to contractors for download and testing. 

Contractors have been directed to have all these ASC update files in production no later than July 28, 2010. This implementation date supersedes the implementation date specified in CR7008.   

ASCs who may have received an incorrect payment determination for certain services furnished on or after June 1, 2010 through the implementation of the July 2010 ASCFS may request contractor adjustment of the previously processed claims.