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CMS proposes changes to inpatient only, ASC covered surgical procedures lists
In the Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule, CMS aims to remove total hip arthroplasty from the inpatient only list and add total knee arthroplasty to the ASC Covered Surgical Procedures List in 2020.
By removing THA from the inpatient only list, CMS noted the procedure would become eligible to be paid by Medicare in both the hospital inpatient and outpatient settings. CMS also proposed to establish a 1-year exemption from medical review activities for procedures removed from the inpatient only list beginning in 2020.
“Specifically, we are proposing that Beneficiary Family Centered Care-Quality Improvement Organization (BFCC-QIO) reviews of short-stay inpatient claims for procedures that have been removed from the [inpatient only] IPO list within the first year will not be counted against a provider in the context of the 2-midnight rule,” CMS wrote in a fact sheet on the proposed rule.
CMS added procedures removed from the IPO list would not be eligible for referral to the Recovery Audit Contractor for 1 year, allowing providers an adequate amount of time “to gain experience with application of the 2-midnight rule to these procedures, and the documentation necessary for Part A payment” for patients who should undergo the procedure in an inpatient setting. Providers would also have time to update their billing system, gain experience with newly removed procedures eligible to be paid under either the inpatient prospective payment system or outpatient prospective payment system and avoid potential adverse site of service determinations.
In addition, CMS proposed to add TKA, knee mosaicplasty and three additional coronary intervention procedures to the ASC Covered Surgical Procedures List (CPL), and is soliciting comment on whether there should be additional limitations on the provision of TKA or other procedures in the ASC setting. CMS is also seeking comments on how to redesign the role of the ASC-CPL to improve physicians’ ability to determine the setting of care as appropriate for individual patients.
In a statement, the American Association of Hip and Knee Surgeons noted there has not been “adequate action to address the issues that arose from the removal of TKA from the [inpatient only] IPO to now support the removal of THA.” AAHKS also noted that standards and procedures should be put in place as part of the addition of TKA to the ASC-CPL to ensure patient safety. AAHKS is working on a comment letter for the CMS and encourages physicians to provide input.
CMS noted the deadline for submitting comments on the proposed rule is Sept. 27, 2019.
References:
www.aahks.org/advocacy/cy2020-opps-asc-pr/