CMS Proposes 2011 Payment Rates for Hospital Outpatient Departments and Ambulatory Surgical Centers
On July 2, 2010, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update the policies and payment rates for services furnished in hospital outpatient departments and ambulatory surgery centers in calendar year (CY) 2011. This proposed rule would also implement applicable statutory requirements of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act or ACA). View CMS press release on this proposed rule »
The proposed rule will be published in the Federal Register on August 3, 2010 and is currently available on the Register's Public Inspection Desk website. Comments on the proposed rule will be accepted until August 31, 2010.
CMS will issue a final rule by November 1, 2010 for services furnished on or after January 1, 2011. The Heart Rhythm Society’s Health Policy staff will continue to review the proposed rule to determine any further impact upon cardiac rhythm services.
Highlights of the Proposed Rule Affecting Heart Rhythm Services
- For CY 2011, CMS proposes a market basket update of 2.15 percent (that is, the CY 2011 estimate increase of 2.4 percent minus 0.25 percentage points), which will result in a conversion factor of $68.267. For hospitals that fail to report quality data requirements, the proposed update is 0.15 percent (minus 2.0 percentage points), resulting in a reduced conversion factor of $66.930.
- CMS proposes to continue to pay for cardiac electrophysiologic evaluation (93619, 93620) and ablation services (93650-93652) using the composite APC (8000) methodology established in CY 2008. The calculated proposed median cost for CY 2011 is approximately $10,834, an increase compared to the CY 2010 cost of $10,026.
- CMS proposes to calculate the median costs for device-dependent APCs for CY 2011 using only the subset of single procedure claims from CY 2009 claims data that
- pass the procedure-to-device and device-to-procedure edits
- do not contain token charges (less than $1.01) for devices
- do not contain the "FB" modifier signifying that the device was furnished without cost to the provider, supplier, or practitioner, or where a full credit was received
- do not contain the "FC" modifier signifying that the hospital received partial credit for the device. This would apply to heart rhythm device-dependent APCs 0084, 0085, 0086, 0089, 0090, 0106, 0107, 0108, 0418, 0654, 0655 and 0680.
- The proposed CY 2011 median cost for APC 0418 (Insertion of Left Ventricular Pacing Electrode), which increased approximately 53 percent from CY 2009 to CY 2010, is projected to decrease approximately 27 percent.
- CMS proposes to continue the policy of reducing payment for specified APCs by 100 percent of the device offset amount when a hospital furnishes a specified device without cost or with a full credit and by 50 percent of the device offset amount when the hospital receives partial credit in the amount of 50 percent or more of the cost for the specified device. This would apply to APCs 0089, 0090, 0106, 0107, 0108, 0418, 0654, 0655 and 0680.
- For CY 2011, CMS proposes to continue use of the 2010 bypass list, which includes codes 93225, 93226, 93231, 93232, 93226, 93270, 93271 and 93278. In addition, CMS is proposing to add to the bypass list codes 93279-93296. Through bypassing specified codes, CMS is able to create "pseudo-single" claims from multiple procedure claims for possible rate setting.
Highlights of the Proposed Rule AffectingAmbulatory Surgical Centers
In addition, the proposed rule would also update policies and payment rates for services in approximately 5,000 Ambulatory Surgical Centers (ASCs).
- The ACA requires the annual update factor for the ASC payment system be reduced by a productivity adjustment, which is estimated to be 1.6 percent for CY 2011. As a result, CMS is projecting a zero percent annual update and a conversion factor of $41.898 for CY 2011.
- CY 2011 marks the end of the transition to the revised ASC payment system. ASC payments will now align with hospital outpatient department payments for corresponding services. As a result, services provided in an ASC would be reimbursed at a rate of approximately 61 percent of the amount paid for services provided in an outpatient department.
Additional information can be found on the CMS website at:
As noted, the Heart Rhythm Society’s Health Policy staff will continue to review the proposed rule to determine any further impact upon cardiac rhythm services.
