Medicare ASC Quality Reporting Toolkit

Background

The Ambulatory Surgical Center Quality Reporting (ASCQR) Program is a pay-for-reporting, quality data program finalized by the Centers for Medicare & Medicaid Services (CMS). Under this program, ASCs report quality of care data for standardized measures to receive the full annual update to their ASC annual payment rate, beginning with Calendar Year (CY) 2014 payments.

ASCs that do not meet the reporting requirements, including allowing the data to be publicly available, may incur a 2.0 percentage point reduction to any annual increase provided under the revised ASC payment system for that year.

ASCs may now register with QualityNet to establish a Security Administrator. The Security Administrator will report Web-based (structural) measures data and be able to access available data submission reports.

For detailed requirements for ASCs participating in the ASCQR Program, refer to the ASCQR Program Reference Checklist.

Specifications Manual

Ambulatory Surgical Centers Quality Reporting (ASCQR) Program

The Ambulatory Surgical Center Quality Reporting Program Quality Measures Specifications Manual provides measure information and specifications for Medicare’s ASC Quality Reporting Program. These standardized measures were selected by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of care for patients in the ASC setting.

Provider Support

As the national support contractor for the ASC Quality Reporting Program, the Health Services Advisory Group (HSAG) is available to answer questions as well as supply other additional information you may need. HSAG provides educational support, feedback, and other services to assist ASCs and other interested parties with quality reporting under the ASCQR Program.

Summary of ASCQR Program Requirements

To meet ASCQR Program requirements and receive the full Annual Payment Update, ASCs must meet administrative, data collection, and data submission requirements. ASCs submit data for quality measures by:

  1. Reporting quality data codes (QDCs) for claims-based measures on the Form CMS-1500 or associated electronic data set.
  2. Answering Web-based (structural) measure questions.

ASCs that do not meet the reporting requirements, including allowing the data to be publicly available, may incur a 2.0 percentage point reduction to any annual increase provided under the revised ASC payment system for that year.

Support Contact

Ambulatory Surgical Centers Quality Reporting (ASCQR) Program

CMS has designated HSAG as the Ambulatory Surgical Centers (ASC) Quality Reporting (QR) Program Support Contractor. HSAG provides technical support and feedback to assist ASCs with quality data reporting.

Submit all questions about the ASCQR Program to HSAG at ASC—Questions/Answers or by calling, toll-free, (866) 800-8756 weekdays from 7 a.m. to 6 p.m. Eastern Time.

Documents that must be submitted to the ASCQR Support Contractor by conventional mail should be sent to:

HSAG
Attn: ASCQR Support Contractor
3000 Bayport Dr., Suite 300
Tampa, FL 33607

Update for ACG Members: “Colonoscopy Measure” Dry Run

Despite concerns from ACG, CMS recently developed a new outcome measure that includes ASCs and Hospital Outpatient Departments (OPDs). This measure is meant to provide facilities with information on patient outcomes that will allow them to improve quality of care for patients undergoing low-risk colonoscopies. The Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy measure will be publicly reported beginning on or after December 1, 2017 and will be used for payment determination beginning calendar year 2018.

CMS conducted a dry run of the colonoscopy measure from July 1 through July 31, 2015. The purpose of the dry run is to familiarize facilities with the measure prior to public reporting.

For an overview of the dry run measure and key dry run dates, refer to the following documents:

  • Fact Sheet – includes a general overview of the measure, briefly describes its development and purpose, and links to QualityNet resources and Q&A email addresses.
  • Dry Run Timeline – shows important dates for the 2015 colonoscopy measure dry run.

Questions and Comments

CMS will receive and respond to facility and stakeholder questions and comments via email during the July 2015 colonoscopy measure dry run. Send questions about the colonoscopy measure to CMSColonoscopyMeasure@yale.edu. To ensure proper handling of inquiries, please reference the provider ID (CCN for OPDs and NPI for ASCs) to which your questions relate. Do NOT submit patient-identifiable information (e.g., Date of Birth, Social Security Number, Health Insurance Claim Number) to this address.

More Background

IS MY FACILITY REQUIRED TO PARTICIPATE IN THE MEDICARE ASC QUALITY REPORTING PROGRAM?

The GI societies have received many questions on whether your ASC is required to participate in the Medicare ASC Quality Reporting Program. Please find below some clarification questions to help determine whether your facility is expected to report quality measures on a CMS-1500 payment claims form.

What is the definition of an ambulatory surgery center (ASC)?

  • According to the Medicare Claims Processing Manual, Chapter 14, an ASC is a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients.1 The ASC must have in effect an agreement with CMS to participate in Medicare.

An ASC 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 either to be an ASC or to be a provider-based department of the hospital as defined in 42 CFR 413.65.2

If a facility meets CMS requirements to participate as an ASC, it bills the Medicare contractor on Form CMS-1500 or the related electronic data set and is paid the ASC payment amount.

  • Please note that the facility may also submit a separate CMS-1500 form for the providers’ professional fee. (Medicare ASC Quality Reporting measures are reported on the CMS-1500 form for the facility fee reimbursement.)
  • Please note that a free-standing facility may submit claims to private insurers using a UB-04 payment claim. However, if the ASC is a free-standing facility participating in Medicare, the ASC submits claims to Medicare using this CMS Form 1500 in order to receive Medicare facility fee reimbursement.

If the facility submits claims to Medicare using a UB-04 claims form, then please check with your administrators as your facility may not be a free-standing or independent facility.3 If your facility is hospital-owned, then it would not participate in the ASC Quality Reporting Program, and instead, participate in the Medicare Hospital Outpatient Quality Reporting (OQR) Program.

Related Questions:

-Our off-site ambulatory surgical area is not licensed by the state as a distinct entity. The Medicare patients are billed using the ASC billing process. If not licensed as an ASC, does this exclude all the cases from the ASC indicators?

  • If the facility is billing Medicare for ASC fee-for-service reimbursements, then the facility will be affected by the requirements and payment effects of the ASC Quality Reporting Program.

-I would like clarification on the definition of an “Ambulatory Surgical Center (ASC)” as it relates to the requirements for the ASC Quality Reporting Program. Are only free-standing ASCs that are billing with their own CMS Certification Number (CCN) included?

  • You are correct. ASCs have their own ASC numbers (the third digit is the letter “C”) and bill using their own payment-claims system.
  • An ASC that is part of a hospital’s regional outpatient facility that is billing under the hospital’s CCN would not be included and therefore not required to participate in the Medicare ASC Quality Reporting program, but instead, Medicare’s quality reporting program for outpatient hospitals. The ambulatory surgery cases billed under the hospital’s CCN would be eligible for inclusion in the relevant measures in the Medicare Hospital Outpatient Quality Reporting (OQR) Program.

Please click here to access the slides from the October 1, 2012 tri-society webinar. (pdf)


1 http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c14.pdf
2 http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=38af2161b33de70fc35286fdbee57ca6&rgn=div5&view=text&node=42:3.0.1.1.3&idno=42#42:3.0.1.1.3.1.1.2
3 http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0729.pdf


Tri-society Webinar on ASC Quality Reporting: How ASCs Report Quality Measures
On June 4, 2012, the ACG, AGA, and ASGE hosted a webinar on the new Medicare ASC Quality Reporting Program to assist gastroenterologists practicing in the ASC setting. The webinar took participants a step further beyond the general overview of the Quality Reporting Program, giving a step-by-step review on how to actually report these quality measures on Medicare reimbursement claims forms.Click here to view the slides from the June 4, 2012 tri-society webinar. (pdf)Click below to watch the webinar. (webinar begins on slide number 5)

On January 23, 2012, the ACG hosted a joint GI society webinar on the forthcoming Medicare Ambulatory Surgical Center (ASC) Quality Reporting Program. The ACG, ASGE, and AGA hope that this webinar will be the first of a series of webinars on this new quality reporting program.
Please click here to view the presentation. (pdf)
Please click here for a simple, one-page “safe surgery” checklist. (Word document)
Please click here to access the tri-society ASC “safe surgery” checklist. (pdf)