View AGA Webinar, Avoid ASC Medicare Penalties

October 18, 2012

Beginning Oct. 1, 2012, CMS requires all Medicare-certified ambulatory surgical centers (ASCs) to report on five facility quality measures or otherwise face a 2 percent Medicare payment penalty in 2014. To help you prepare, AGA, ACG and ASGE recently hosted the last in a series of three webinars on the ASC Quality Reporting Program. View the webinar.

During the webinar, there were many questions regarding which ASCs are required to participate in the program. According to CMS, an ASC is a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients and is either free-standing/independent (i.e., not a part of a provider of services or any other facility) or operated by a hospital (i.e., under the common ownership, licensure or control of a hospital). A hospital-operated facility has the option of being considered by Medicare to be either an ASC or a provider-based department of the hospital.

If the facility meets CMS requirements to participate as a free-standing/independent ASC, it bills the Medicare contractor on form CMS-1500 or the related electronic data set. The ASC Quality Reporting Program applies to these ASCs.

However, if the facility submits claims to Medicare using a UB-04 form, it is likely hospital-owned and would not participate in the quality reporting program. Instead, the facility would be eligible to participate in the Medicare Hospital Outpatient Quality Reporting Program.

CMS has designated Florida Medical Quality Assurance, Inc. (FMQAI) as the ASC quality reporting program support contractor. FMQAI provides technical support and feedback to assist ASCs with quality data reporting. Submit your questions online or by calling, toll-free, 866-800-8756 weekdays from 7 a.m. to 6 p.m. ET.

For additional information about the program, visit AGA’s tools for GI ASCs or the QualityNet website.

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