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Ambulatory Surgery Reimbursement Update

Ambulatory Surgery Regulation Update is a weekly e-mail newsletter that offers news and stories about regulatory issues in ambulatory surgery, like certificate of need legislation and physician ownership issues, presented in a "quick-read" format. You'll also receive links to industry reports as available.

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Ambulatory Surgery Reimbursement Update

Issue 11, March 17, 2005

• Conducting and documenting meetings

  You may be expected by your organization to give every employee an opportunity to participate in a...

• Senator calls for independent drug safety office for FDA

  A top Senate Republican plans to put forth legislation that would create an independent drug safety...

Issue 41, October 11, 2005

• No change in Medicare payment for ASCs

  Medicare payment rates and wage index values for services provided in ambulatory surgery centers...

• FASA relief center to assist hurricane victims

  The Federated Ambulatory Surgery Association (FASA) has established an online relief center to...

Issue 52, December 28, 2005

• Congress cuts 2007 Medicare ASC payments for 2007

  Congress approved reimbursement cuts to those ambulatory surgery center (ASC) procedures that are...

• HHS Secretary proposes expansion of ASC list

  Health and Human Services (HHS) Secretary Michael O. Leavitt has indicated in a letter his...

• Congress: CMS responsibile to address specialty hospital concerns

  The Centers for Medicare & Medicaid Services (CMS) is responsibile for "developing a strategy for...

Issue 51, December 20, 2005

• AAASC lobbies for ASCs in proposed exception to self referral for EHR

  The American Association for Ambulatory Surgery Centers (AAASC) recently wrote to the Centers for...

• Washington DOH issues Non-Hospital Surgical Settings Advisory Work Group Report

  The Washington Department of Health (DOH) has issued the latest Non-Hospital Surgical Settings...

• AMA issues statement on averted Medicare physician payment cut

  The American Medical Association (AMA) has issued a statement voicing the association's...

Issue 50, December 13, 2005

• IOM report supports national performance measures

  A new Institute of Medicine (IOM) report urged Congress to establish a system to measure and report...

• HL7 to release new set of standards

  Health Level Seven (HL7) will release a new set of standards to its members that will provide a...

• Rechargeable neurostimulators receive HCPCS codes

  The Centers for Medicare & Medicaid Services (CMS) has approved Boston Scientific Corp.'s...

Issue 49, December 6, 2005

• AAAHC announces 2006 revisions to accreditation standards

  The Accreditation Association for Ambulatory Health Care (AAAHC) has announced the 2006 revisions...

• JCAHO releases draft 2007 National Patient Safety Goals for ambulatory surgery

  Worker fatigue, disruptive behavior, and orientation for temporary workers are among the five new...

• MGMA: Orthopedics may have hit financial plateau

  A new report from the Medical Group Management Association (MGMA) seems to indicate that orthopedic...

Issue 48, November 29, 2005

• New report shows smaller ASCs have higher net income

  A new report from the Medical Group Management Association (MGMA) shows that smaller ambulatory...

• HHS still seeking comments on electronic claims attachments proposal

  The Department of Health and Human Services (HHS) has extended the public comment period for the...

Issue 47, November 22, 2005

• CMS issues changes to Medicare ASC list

  The Centers for Medicare & Medicaid Services (CMS) has issued changes to the ambulatory surgery...

• 2006 OIG Work Plan focuses heavily on Medicare Part D

  The Office of Inspector General (OIG) has issued its 2006 Work Plan, which details plans for...

• Bush to approve Medicare physician rate increases if funding available

  The administrator for the Centers for Medicare & Medicaid Services (CMS) said the Bush...

Issue 46, November 15, 2005

• Study shows angioplasties safe in outpatient setting

  New research indicates patients who undergo angioplasty in an outpatient setting are in no more...

• Gingrich calls on Congress to address specialty hospitals

  In an opinion piece printed in The Washington Post , Newt Gingrich, former speaker of the House of...

• Missouri updates Medicare-covered ASC list

  Missouri's Division of Medical Services announced last month the addition and deletion of codes...

Issue 45, November 8, 2005

• HOPD Medicare payment rates to increase by at least 3.7%

  The Centers for Medicare & Medicaid Services (CMS) has announced that payment rates to hospital...

• Reimbursement rates for physicians cut 4.4% in 2006

  A final federal rule from the Centers for Medicare & Medicaid Services (CMS) issued November 2 will...

• Study shows methods for efficiency in centers performing myringotomy

  A survey conducted by the Accreditation Association for Ambulatory Health Care (AAAHC) Institute...

Issue 44, November 1, 2005

• Support grows for ASC Medicare Payment Modernization Act

  Several members of the House of Representatives have cosponsored the "Ambulatory Surgical Center...

• Medicare takes step to ease physician quality reporting

  Medicare has created a program that will make it easier for physicians to participate in a...

• CMS devotes Web page to NPI

  The Centers for Medicare & Medicaid Services (CMS) now has a Web page for facilities to obtain...

Issue 43, October 25, 2005

• View recent ASC payment legislation

  Over the last several weeks, legislators have introduced legislation in both the Senate and the...

• MA residents to have access to cost data for ASCs

  A new online resource in Massachusetts will soon give patients access to information regarding the...

• New cohesive gel implant may be next on to market

  A new cohesive gel implant that offers patients more natural looking breasts and a low complication...

Issue 42, October 18, 2005

• ASC payment modernization act introduced

  Representative Wally Herger (R-CA) has introduced legislation that calls for the establishment of a...

• NQF endorses additional ambulatory care standards

  The National Quality Forum (NQF) has endorsed six new voluntary consensus standards for ambulatory...

• Hispanics at higher risk for cataracts

  A new study has revealed that Hispanic adults are more likely to have cataract-related vision...

Issue 41, October 11, 2005

• AMA offering grants to physicians affected by hurricanes

  The American Medical Association (AMA) Foundation is offering grants to assist physicians whose...

• AMA offering grants to physicians affected by hurricanes

  The American Medical Association (AMA) Foundation is offering grants to assist physicians whose...

• No change in Medicare payment for ASCs

  Medicare payment rates and wage index values for services provided in ambulatory surgery centers...

• FASA relief center to assist hurricane victims

  The Federated Ambulatory Surgery Association (FASA) has established an online relief center to...

• FASA relief center to assist hurricane victims

  The Federated Ambulatory Surgery Association (FASA) has established an online relief center to...

• FASA relief center to assist hurricane victims

  The Federated Ambulatory Surgery Association (FASA) has established an online relief center to...

Issue 40, October 4, 2005

• AMA goes to Congress, pushing to stop Medicare payment cuts

  The American Medical Association (AMA) went before Congress last week in its ongoing effort to put...

• Legislation requires accreditation for performing certain procedures

  New legislation in North Carolina and regulations in Tennessee will require ambulatory healthcare...

• CMS announces voluntary system for reporting quality data

  The Centers for Medicare and Medicaid Services (CMS) is establishing a system for physicians to...

Issue 39, September 27, 2005

• FDA approves second silicone breast implant

  The Food and Drug Administration (FDA) has approved a second manufacturer of silicone gel-filled...

• Procedure makes cochlear implant surgery safer

  Researchers have developed a new minimally invasive procedure that reduces risks associated with...

• HHS releases proposed claims attachment rule

  The United States Department of Health and Human Services (HHS) has published a proposed rule for...

Issue 38, September 20, 2005

• FASA, AAASC rally for change to Medicare payment system

  Both the Federated Ambulatory Surgery Association (FASA) and the American Association for...

• Medicare Part B monthly premium rises more than $10

  Rapid growth in the intensity and utilization of Part B services in hospital outpatient services is...

• Certified nurses wanted for Katrina relief

  The American Nurses Association and the American Nurses Credentialing Center are recruiting 100...

Issue 37, September 13, 2005

• New worker's compensation manual now in effect

  The 2005 edition of the Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical...

• New study shows gender a non-factor for angioplasties

  A new study indicates that the gender of the patient does not affect the outcome in patients...

• AMA working with licensing boards to assist displaced physicians

  The American Medical Association (AMA) has announced that it is making its online service...

Issue 36, September 6, 2005

• AAASC issues position statement on ASC charity care

  In response to recent reports claiming that ASCs provide small amounts of charity care compared to...

• JCAHO introduces new accreditation approach for ambulatory care systems

  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is exploring a new way to...

• AORN requests comment on handling specimens practice

  The Association of periOperative Registered Nurses (AORN) is requesting public comment on its...

Issue 35, August 30, 2005

• CMS schedules Medicare provider feedback meeting

  The Centers for Medicare & Medicaid Services (CMS) has scheduled a Town Hall meeting to solicit the...

• Study shows women often choose mastectomy over lumpectomy

  Despite most surgeons pushing for lumpectomy for the surgical treatment of breast cancer, women...

• AMA brings Medicare message to Ohio

  The American Medical Association (AMA) brought its concerns about future access-to-care problems...

Issue 34, August 23, 2005

• CMS issues guidance to ASCs wishing to bill patients for P-C IOLs

  The Centers for Medicare & Medicaid Services (CMS) issued a transmittal offering guidance for...

• AMA lobbies against Medicare cuts in three states

  The American Medical Association (AMA) continued its efforts to draw attention to possible effects...

• CMS schedules roundtable discussion on NPI

  The Centers for Medicare & Medicaid Services (CMS) has scheduled a roundtable discussion about the...

Issue 33, August 16, 2005

• CMS issues list of CLIA waived tests

  The Centers for Medicare & Medicaid Services (CMS) issued a transmittal detailing a list of...

• Medicare no longer reimbursing ASCs for NTIOLS

  Ambulatory surgery centers (ASC) can no longer receive an additional $50 reimbursement from...

• Study shows orthopedics owning an ASC see costs rise

  A recent survey indicates that orthopedic practices saw a larger percentage increase in costs than...

Issue 32, August 9, 2005

• October deadline for non-HIPAA compliant Medicare claims

  Beginning October 1, 2005, the Centers for Medicare & Medicaid Services (CMS) will not process...

• NQF endorses voluntary consensus standards for ambulatory care

  The National Quality Forum (NQF) has announced its endorsement of a set of National Voluntary...

• State sets out to improve office-based surgery following tragedy

  The New York health commissioner is reconstituting a special advisory panel to study and recommend...

Issue 31, August 2, 2005

• Medical error bill signed into law

  President Bush has signed into law legislation that could help reduce medical mistakes and improve...

• U.S. House backs bill to limit malpractice suit awards

  Legislation that would limit malpractice suit awards for pain and suffering lawsuits to $250,000...

• Mentor receives 'approvable letter' for silicone breast implants

  The two largest plastic surgery membership organizations are applauding the Food and Drug...

Issue 30, July 26, 2005

• Research studies claim specialty hospitals treat less ill patients

  Two new studies show that patients who underwent two types of cardiac procedures at specialty...

• CMS to gather views on ASC payment reform

  CMS has scheduled an ASC Listening Session to gather feedback from individual ASCs on a number of...

• Annual national ASC open house day on August 2

  The Federated Ambulatory Surgery Association (FASA) is holding its third annual open house day on...

Issue 29, July 19, 2005

• Michigan program looks to improve weight-loss surgery

  A new quality-improvement program in Michigan hopes that paying hospitals with large weight-loss...

• ASAPS warns against offshore injectables

  The American Society for Aesthetic Plastic Surgery (ASAPS) is suggesting that patients should be...

• Surgery mistakes may prove costly for state doctors

  Florida's state medical board is pushing for stricter penalties for surgeons who operate on the...

Issue 28, July 12, 2005

• ASC cost study launched by GAO

  The Government Accountability Office (GAO) this month will issue surveys to 50 Medicare-certified...

• FASA submits procedure list comments to CMS

  The Federated Ambulatory Surgery Association (FASA) submitted comments last week to CMS on the...

• Weight-loss surgery reduces heart disease risk

  A new study shows that gastric bypass surgery reduces the risk of heart disease even more than...

Issue 27, July 5, 2005

• CMS releases updated ICD-9-CM codes list

  The Centers for Medicare & Medicaid Services (CMS) released its annual update of the list of...

• ASHA responds to CMS’ discussion on defining a hospital

  There is no legal basis for Medicare to establish one set of participation standards for the...

• Studies suggest long-term, possibly lethal effects of anesthesia

  Two recently published studies linking deep sedation and an increased risk of the death within the...

Issue 26, June 28, 2005

• Medicare’s ASC list effective July 1

  The Centers for Medicare & Medicaid Services (CMS) has issued some technical corrections to the...

• State reexamining CON laws

  Legislators in South Carolina are trying to determine whether to improve or remove the...

• Doctors want company’s involvement in device recalls changed

  Following recent high-profile recalls of implants such as defibrillators made by Guidant Corp. and...

Issue 25, June 21, 2005

• Outpatient surgery prices available by ’07

  Under a new law signed last week, patients in Illinois will be able to view on the Internet the...

• Medical data bill could save lives, money

  A new national standard for secure, electronic medical records accessible on one central data...

• Study shows computers improve patient satisfaction

  The introduction of computers results in improved communication about medical issues and patient...

Issue 24, June 14, 2005

• Specialty hospital moratorium ends, but immediate construction not expected

  Despite the end to an 18 month federal moratorium on new specialty hospitals last Tuesday...

• Legislation would ban hospitals and corporations from directly employing docs

  The American Medical Association (AMA) is recommending the development of legislation that would...

• Ruling limits prosecution of some HIPAA violators

  A new ruling by the Justice Department will limit the government’s ability to prosecute...

Issue 23, June 7, 2005

• No volume increase after surgeon investment in specialty hospital

  The results of recently released study indicate that orthopaedic surgeons did not increase their...

• Survey shows doctors changing practices in fear of lawsuits

  A majority of physicians were shown to order unnecessary diagnostic tests or simply avoiding...

• Medicare asked to cover more obesity surgery

  The Centers for Medicare & Medicaid Studies (CMS) was asked by a surgical group and several makers...

Issue 22, May 31, 2005

• AMA urging support to protect physician payment rates

  The American Medical Association (AMA) is lobbying for support against an announcement that...

• Advocacy groups want more answers for silicone implants

  The National Women’s Health Network, along with 16 other consumer advocacy groups, have...

• Medicare chief wants rewards for successful physicians

  The head of the Centers for Medicare & Medicaid Services (CMS) said physicians that help the...

Issue 21, May 24, 2005

• AAASC creates New ASC state advocacy program

  The American Association for Ambulatory Surgery Centers (AAASC) has announced the creation of a new...

• Effect of specialty hospitals may get closer look

  Texas may have to take a closer look at how niche hospitals affect the financial viability of other...

• Judge rules doctors can sue HMOs; insurers fighting decision

  A state appeals court has ruled that providers can sue insurers over charges of reduced or slow...

Issue 20, May 17, 2005

• Medicare patients can choose presbyopia-correcting IOLs

  The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare beneficiaries can...

• CMS: No new specialty hospital facilities for rest of the year

  CMS will not approve any new specialty-hospital applications this year so the agency can continue...

• Free posters assist needy Medicare beneficiaries

  CMS is offering free posters titled "Have Limited Income? Social Security Can Help with...

Issue 19, May 10, 2005

• New CPT code payable in an ASC

  The Centers for Medicare & Medicaid Services (CMS) has announced that CPT code 66711 is now payable...

• NQF receives grant for ambulatory care project

  The National Quality Forum (NQF) has received a $2.5 million grant from the Robert Wood Johnson...

• Hospitals dropped from CON requirement

  A bill requiring ASCs and diagnostic imaging centers in Oregon to go through the Certificate of...

Issue 18, May 3, 2005

• CMS releases updated Medicare-approved ASC list

  The Centers for Medicare & Medicaid Services (CMS) announced its changes to the list of approved...

• Simple weightloss technique may not be safe

  Patients should be wary of turning to mesotherapy as a weightloss alternative to liposuction...

• CMS announces raise in Medicare interest rates

  CMS announced that it has raised the interest rate for Medicare overpayments and underpayments to...

Issue 17, April 26, 2005

• Dental surgeons look to sink teeth into plastic surgery

  Lawmakers have introduced legislation that would allow oral and maxillofacial surgeons to perform...

• NQF proposes ambulatory-care standards

  The National Quality Forum (NQF) has released a draft report outlining 50 standards to measure and...

• Proposed bill would assess problems with office-based surgery

  A proposed bill in Nevada may be the first step toward ensuring that office-based procedures are as...

Issue 16, April 19, 2005

• Senator asks CMS to reduce proposed list deletions

  The chairman of the Senate Finance Committee has sent a letter to the Centers for Medicare and...

• JCAHO establishes two ambulatory care councils

  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established two new...

• AAASC seeks insurance payer information

  The American Association of Ambulatory Surgery Centers (AAASC) is looking for information from ASCs...

Issue 15, April 12, 2005

• Study: Increased ASC use could save Medicare $1.6 billion annually

  Healthcare policy-makers searching for an answer to the escalating cost of Medicare might be...

• SC institutes cap on noneconomic malpractice damages

  South Carolina joined a number of other states in setting a cap on "pain and suffering" damages in...

• Cosmetic surgery thrives, while reconstructive surgery falters, statistics say

  Optional cosmetic surgery has become one of the medical industry’s fastest-growing...

Issue 14, April 5, 2005

• Appeal made for nationwide insurance coverage

  The chief executive and president of Massachusetts’ largest hospital and physician network...

• Bill would require reporting of ASC procedure prices

  The U.S. House of Representatives is considering legislation that calls for the disclosure of...

• Weight reduction surgery proposal doesn’t get off ground

  An act that would require insurance companies in Connecticut to cover obesity surgery deemed...

Issue 13, March 29, 2005

• Knee arthroscopies performed at ASCs improve in quality

  Ambulatory surgery centers (ASCs) seem to be getting knee arthroscopies and the attending proceses...

• SD puts greater trust in nurse anesthetists

  The state of South Dakota became the 13th state to opt out of a federal regulation set down by the...

• Happy National Doctors Day Eve!

  There’s only one more shopping day left to find that perfect special something to give the...

Issue 12, March 22, 2005

• Massive weight loss leads to gain for body contouring

  People who successfully achieve massive weight loss are contributing to a significant increase in...

• Cosmetic surgery tax could help pay for public schools

  Texas has joined the growing list of states considering a "vanity tax" on plastic surgery...

• Hispanics leading minority group for cosmetic surgery

  An increasing number of Hispanics are having cosmetic surgery, according to a report by the...

Issue 11, March 16, 2005

• MedPAC: Extend specialty hospital ban

  The Medicare Payment Advisory Committee (MedPAC) has advised the Centers for Medicare and Medicaid...

• Pennsylvania ASCs can resume laparoscopic surgery

  Ambulatory surgery centers (ASCs) in Pennsylvania can resume performing laparoscopic procedures...

• Abortion clinics may become ASCs

  A bill that would redefine abortion clinics in Missouri as ASCs won first-round approval in the...

Issue 10, March 8, 2005

• Texas ASCs win reimbursement boost

  Ambulatory surgery centers (ASCs) in Texas will soon receive separate reimbursement of surgically...

• Nevada physicians may have to submit sedation information

  A new bill introduced in Nevada may eventually require physicians to submit information about any...

• Efforts fail in Colorado to stop physician credentialing restrictions

  A tie vote means legislation prohibiting hospitals in Colorado from restricting the credentialing...

Issue 9, March 1, 2005

• Cosmetic surgery not prevalent in young women

  Concerns that many young women are racing out of the home and into a cosmetic surgeon’s...

• ASHA: Report supports need to eliminate moratorium

  The American Surgical Hospital Association (ASHA) has said that a report the group commissioned...

• FDA seeks comment on medical device injury rule

  The U.S. Food and Drug Administration (FDA) wants to amend the regulations governing the reporting...

Issue 8, February 22, 2005

• FDA hopes for no drug safety oversights with committee

  The U.S. Food and Drug Administration (FDA) has announced the creation of an independent board...

• Virginia ASCs not the standard for abortion clinics

  Despite the urging of abortion opponents, abortion clinics in Virginia will not have to meet the...

• ASPS: Cosmetic surgery taxes won’t solve state’s financial woes

  In response to Washington becoming the third state to propose a cosmetic surgery tax, the American...

Issue 7, February 15, 2005

• Nurse anesthetics can continue working with surgeons

  Nurse anesthetics in New Jersey can continue, for the time being, to work with surgeons in an...

• Amendment could mean profiling for NY ASCs

  Ambulatory surgery centers (ASCs) in New York could be subject to data collection to improve...

• SC health plan requires accreditation, supports multi-specialties

  The final version of the South Carolina Health Plan has been approved, and any unaccredited or...

Issue 6, February 8, 2005

• Washington looking into the need to review CON

  The state of Washington is looking to improve and update its certificate of need (CON) program by...

• Academy requiring accreditation for cosmetic surgeons

  If you've been lifting foreheads or putting implants in buttocks in an unaccredited facility, and...

• Colorado's ASC association trying to protect physician owners

  The Colorado Ambulatory Surgery Center Association has introduced legislation seeking to protect...

Issue 5, February 1, 2005

• Montana prescribing fines for sloppy doctors

  Does that say Vicodin or Vytorin? Pharmacists ask that question, and hundreds like it, every day...

• Associations submit comments to CMS on procedure list

  The American Association of Ambulatory Surgery Centers (AAASC) and the Federated Ambulatory Surgery...

• Trial set to challenge Mississippi abortion law

  Ambulatory surgery centers and other outpatient surgical facilities in Mississippi may find...

Issue 4, January 25, 2005

• Medicare finalizes prescription drug rule

  The elderly may be able to save money and gain access to more prescriptions, thanks to Medicare...

• New UB-04 form from the NUBC

  With the eight-year moratorium on changes to the UB-92 data structure over, its successor, the...

• Arkansas aims to ban smoking on medical facility grounds

  Smokers in Arkansas may find this news a drag: A bill introduced in the state could prohibit the...

Issue 3, January 18, 2005

• Loss of life not acceptable result of weight-loss surgery

  With more and more people turning to weight-loss surgery as the answer for obesity, health...

• ’Never events’ getting no more payment

  If it's never supposed to happen, then the hospital shouldn't get paid if it does. That's the...

• You heard right: More coverage for cochlear implants

  More patients suffering from hearing loss may soon receive implants helping to recreate sound...

Issue 2, January 11, 2005

• DEA seeks multiple registrations for doctors practicing in multiple states

  Life may be getting a little more difficult and expensive for physicians who prescribe controlled...

• Payments for IOLs facing reduction

  For ambulatory surgery centers (ASCs) receiving payment for intraocular lenses (IOLs), the money...

• Copay or no pay? Docs to get new drug buy options

  Although it may be a year away, Medicare-certified physicians should be aware that they will soon...

Issue 1, January 4, 2005

• ASC antitrust lawsuit will go to trial in NY

  A federal judge has ruled that a four-year-old antitrust lawsuit focusing on the right of...

• Surgeons think teens should wait for breast augmentation

  Responding, perhaps to some degree, to the incessant media speculation about the physical...

• AAO and VA see eye-to-eye on surgery

  At the urging of ophthalmologists and advocacy groups like the American Academy of...