Contracts for Ambulatory Surgical Center Locations Affected
CMS has changed how fee amounts are handled so that all codes are now paid at the facility rate. This change is retroactive to 2008.
When you download your Medicare fee schedules for 2009, they will of course reflect this change. But for your 2008 ASC contract(s), you have a decision to make. Your existing Medicare contract for ASC calculates the fee amount according to the methodology in place in early 2008, i.e., codes specified as relating to an ASC use the facility rate while other codes (assuming Medicare covers them) use the non-facility rate. You have presumably already submitted most of your 2008 ASC charges and received payment from your carrier. But those that have not yet been paid will be reimbursed using the new payment system.
If you keep your existing 2008 ASC fee schedule, some charges (probably not many) may wind up in payment audit that no longer belong there.
On the other hand, if you delete your ASC contract and re-download it, you will get a fee schedule that uses the new methodology for calculating the fee amount. When you run month-end, DataPlus will re-calculate the expected payment. For the most part, this won't affect payment audit since the facility rate is usually lower than the non-facility rate.
There are seven codes, however, where the facility amount is actually higher (17340, 21800, 23570, 27193, 27200, 27767, and 67820). If you r Contract Dollar Threshold is more than $4.00, there will be no impact on payment audit.
Although downloading the revised ASC fee schedule for 2008 will have little or no impact on audit for Medicare patients, there is something else to consider before deciding on this option. Are you planning to add contracts based on a percentage of the Medicare ASC amount for 2008? If so, which methodology will these contracts use? If you already have such contracts, will you revise them to use the new payment method?
Think carefully before you decide. Once you download the revised Medicare ASC fee schedule for 2008, you won't be able to get the old one back!
If you have any questions, please contact support at support@mydataplus.com, or dial 1-888-688-3282.
