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  • ASC Payment ASC Quality Reporting

    ASCs to See 1.1 Percent Payment Increase Under 2016 Proposed Rule


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    For the first time ever, the Centers for Medicare and Medicaid Services plans to increase payments to ambulatory surgery centers slightly more than those to outpatient hospitals. The proposed 2016 ASC payment rule, released July 1, would increase ASC payments 1.1 percent. CMS proposes to cut payments for hospital outpatient services by minimum of 0.01 percent.

    ASCs’ 2016 conversion factor will depend on their 2014 performance on quality reporting measures.

    • ASCs that failed to report successfully will receive a 2 percent penalty.
    • ASCs that reported successfully will be paid based on a 2016 conversion factor of $44.605.

    The proposed rule included several other important ophthalmology related proposals. 

    • Corneal tissue grafts in glaucoma shunt surgery: CMS plans to reverse a payment change the Academy pushed for. In 2016, CMS plans to go back to a bundled payment for corneal tissue patch grafts that are provided with glaucoma shunt procedures. The current facility payment doesn’t cover the cost of the tissue.

      Just months ago -- in April – CMS agreed to pay for the tissue pass-through in the same manner as cornea tissue used for transplants. The Academy and the American Glaucoma Society pushed strongly for coverage of the tissue cost
    • ASC-11 reporting: CMS retains voluntary reporting on the ASC-11, Improvement in Patient’s Visual Function Within 90 Days Following Cataract Surgery, quality reporting measure. The Academy pushed strongly to eliminate mandatory reporting.
    • New unplanned vitrectomy measure: CMS proposes a new quality-reporting measure. The Academy, American Society of Cataract and Refractive Surgery and Outpatient Ophthalmic Surgery Society all support the vitrectomy measure.
    • Coverage for retinal prosthesis system: CMS proposes a new payment classification for the Argus® II system -- APC 1593. In the hospital outpatient setting, CMS would pay $75,000 for APC 1593.
    • Cataract, glaucoma drug bundling: CMS will bundle two drugs that currently have a “new technology” pass-through. CMS said the drugs function as a surgical supply, which is typically included in the payment for the procedure.
      • In 2016, CMS would bundle HCPCS code J7315, mitomycin ophthalmic, 0.2mg for glaucoma surgery.
      • In 2018, CMS would bundle HCPCS code C9447 injection, phenylephrine and ketorolac, 4 ml vial for cataract surgery.