Kathy Bryant of the ASC Association Discusses Critical Regulatory Issues

With all of the recent changes made in these areas, now is a good time for ASCs to review their policies to ensure that they are up-to-date and, thus, that their ASC is in conformance with the regulations, according to Ms. Bryant.

Here, Ms. Bryant discusses some of these major issues and offers suggestions as to what ASCs can do to address them.

Greater scrutiny by the government
Over the past year, the federal government has placed increased scrutiny on potential Medicare fraud from insurance companies and physicians. Recent cases have included individuals or companies overcharging for services or using flawed data to determine what amount should be charged for procedures.

To date, ASCs have not seen excessive scrutiny, but Ms. Bryant cautions ASCs not be complacent on this issue.

"Just because ASCs haven't been the targets of enforcements, such as those conducted by the [recovery audit contractors], it doesn't mean that they won't be [targets] in the future," she says. "Most ASCs are following the correct policies when it comes to Medicare regulations, but with the new, more complicated system it makes sense for ASCs to review their billing procedures and policies and make any adjustments needed."

"Small issues can quickly become big issues," she says, emphasizing the importance that ASCs remain aware.

Conditions for Coverage
The changes in the Medicare Conditions for Coverage that went into effect on May 18 provide a perfect reason for ASCs to take a look at their policies to ensure that they are in compliance with these new regulations. 

"This is an excellent time for ASCs to conduct a proper review of their policies and make adjustments so that they can meet the new requirements," Ms. Bryant says. "Although it will be a little while before state surveyors must start using the new criteria, any surveys conducted as the result of a complaint is under these new standards.

"If ASCs use their available resources and stay informed about the new conditions and stay in compliance, it will make it easier for us to make the necessary changes," Ms. Bryant says.

One such change has already occurred, further illustrating the importance for surgery centers to keep up-to-date on the new policies. After CMS reevaluated its original policy at the request of the ASC Association and ASCs across the country, ASCs may perform same-day procedures on Medicare patients who meet certain conditions.

"CMS did the right thing in reconsidering its original policy that would have banned same-day patient care in ASCs," says Ms. Bryant. "With our members' help, we were able to provide numerous specific examples of patients that would be harmed by this policy. We are pleased to see that CMS listened to the ASC Association and its members on this issue."

Payment issues
The growing disparity between Medicare payments for ASCs and those for hospital outpatient departments remains a hot-button topic.

Rather than setting the rates based upon the HOPD system, the Medicare reimbursement payments for ASCs undergo "secondary rescaling," resulting in even lower payments for ASCs.

As a solution, the ASC Association supports legislation introduced in Congress designed to fix this and other issues regarding Medicare payments. This legislation, H.R. 2049, introduced by U.S. Representatives Kendrick Meek (D-Fla.) and Wally Herger (R-Calif.) would set the rate at 59 percent of the HOPD rate, according to Ms. Bryant.

Taking proactive action
The overall impact of ASCs in the local and healthcare communities is one that is largely unknown by many lawmakers, Ms. Bryant says. As a result, ASCs have often been added in as a sidebar to many pieces of healthcare legislation.

"ASCs have a great story to tell," she says. "Washington, D.C., doesn't really understand
[the role of ASCs in the healthcare industry]."

In order to get the message out about ASCs and to make certain ASCs have their voices heard, Ms. Bryant encourages ASCs to make their presence known to their members of Congress and other legislators. 

"Nothing can replace [in effectiveness] a constituent coming to visit their legislator," Ms. Bryant says. She encourages ASC professionals to lobby in Washington.

Making an impact requires that ASCs are aware of the issues that are at hand, says continues Ms. Bryant. She notes that the ASC Association provides information on its Web site and has staff that can help and are "just a phone call away."

"ASC professionals who know the issues can then use this information to keep others at their ASCs and in their communities in the know," says Ms. Bryant.

She encourages all ASCs to write their members of Congress and urge them to cosponsor H.R. 2049. "The change won't happen in 2009, but hopefully, these issues will be resolved in 2010 if ASCs across the country give just a little time to the effort," she says. 

Outreach goes beyond Washington, D.C., Ms. Bryant says. She notes the importance of educating the community about what ASCs provide. "The biggest impediment [to our success] is people not knowing what the benefits of ASCs are," she says. (Note: Read what the CEO of one ASC recently did to help spread the message about the benefits of surgery centers by clicking here.)

Ms. Bryant also encourages ASCs to bring members of the community into their facilities by participating in National ASC Open House Day, hosting health fairs and sponsoring events with other local community groups so that the public is aware of what ASCs offer their communities.

Learn more about the ASC Association at www.ascassociation.org.