Thursday, June 24, 2010

What are the services included in ASC


The ASC payment rate includes only the specifically identified ASC services, included on the ASC payment list. All other non-ASC services such as physician services, prosthetic devices, etc. may be covered and separately billable under Medicare Part B. The Medicare definition of covered facility services for a covered surgical procedure includes services that would be covered if furnished on an inpatient or outpatient basis in connection with a covered surgical procedure. This includes operating and recovery rooms, patient preparation areas, waiting rooms, and other areas used by the patient or offered for use to patient’s needing surgical procedures. It includes all services and procedures provided in connection with covered surgical procedures furnished by nurses, technical personnel and others involved in patient’s care. These do not include physician services, or medical and other health services for which payment may be made under other Medicare provisions (e.g., services of an independent laboratory located on the same site as the ASC, prosthetic devices other than intra-ocular lenses (IOLs), anesthetist’s professional services, and non-implantable durable medical equipment (DME).
ASC services for which payment is included in the ASC payment for a covered surgical procedure include, but are not limited to the following.

Included facility services:
• Nursing, technician, and related services;
• Use of the facility where the surgical procedures are performed;
• Any laboratory testing performed under a CLIA certificate of waiver;
• Drugs and biologicals for which separate payment is not allowed under the hospital outpatient prospective payment system (OPPS); (effective January 1, 2008)
• Medical and surgical supplies not on pass-through status; (effective January 1, 2008)
• Equipment;
• Surgical dressings;
• Implanted prosthetic devices, including intraocular lenses (IOLs), and related accessories and supplies not on pass-through status; (effective January 1, 2008)
• Implanted DME and related accessories and supplies not on pass-through status; (effective January 1, 2008)
• Splints and casts and related devices;
• Radiology services for which separate payment is not allowed under the OPPS, and other diagnostic tests or interpretive services that are integral to a surgical procedure; (effective January 1, 2008)
• Administrative, recordkeeping and housekeeping items and services;
• Materials, including supplies and equipment for the administration and monitoring of anesthesia; and
• Supervision of the services of an anesthetist by the operating surgeon.

Under the revised ASC payment system, the above items and services fall within the scope of ASC facility services, and payment for them is packaged into the ASC payment for the covered surgical procedure. ASCs must incorporate charges for packaged services into the charges reported for the separately payable services with which they are provided. Because contractors pay the lesser of 80 percent of actual charges or the ASC payment rate for the separately payable procedure, and because this comparison is made at the claim line-item level, facilities may not be paid appropriately if they unbundle charges and report those charges for packaged codes as separate line-item charges.
There is a payment adjustment for insertion of an IOL approved as belonging to a class of NTIOLs, for the 5-year period of time established for that class.

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