Medicare Quality Reporting for ASC Clients

If you are an ambulatory surgery center client, please take note of the following:

abeo will ONLY report Claims-Based Measures for Medicare Quality Reporting.
abeo will NOT be fulfilling the requirement of each ASC to report Structural Measures.

We want to make sure your ASC understands the difference between the Claims-Based Measures and Structural Measures. The following excerpts have been taken from the ASC Quality Measures Specifications Manual. Centers for Medicare and Medicaid. Updated December 2012.

Quality Reporting for Ambulatory Surgical Centers
A quality reporting program for ASCs was finalized by the Centers for Medicare and Medicaid Services (CMS) in the Calendar Year (CY) 2012 OPPS/ASC Final Rule with Comment Period (CMS-1525-FC). Five claims-based measures (four outcome measures and one process of care measure) were adopted for the CY 2014 payment determination. For the CY 2015 payment determination, two structural measures (surgical procedure volume and safe surgery checklist use) were adopted in addition to the five original claims-based measures for a total of seven quality measures. For the CY 2016 payment determination, the same claims-based and structural measures as adopted for the CY 2015 payment determination and one process of care measure were adopted.

Data Collection and Submission
Data for claims-based measures included in this specifications manual are to be reported for Medicare Part B fee-for-service (FFS) patients admitted to the ASC during required reporting periods (see Table 1). Medicare Part B FFS patients include Medicare Railroad Retirement Board patients and Medicare Secondary payer patients. Medicare Advantage patients are not included.

Reporting on claims-based measures began October 1, 2012 for Medicare Part B FFS patients where Medicare was the primary payer. Reporting on claims-based measures where Medicare is the primary or secondary payer begins on January 1, 2013. Reporting for Medicare secondary payer claims was delayed until January 2013 due to the timing of commercial payer system code updates.

For claims-based measures, the reporting period refers to dates of service, not to any other date associated with claims processing such as the claim submission date. For example, if a service was provided on December 30, 2012 with claim submission on January 1, 2013, this claim would not be included in the CY 2015 payment decision data because the service date was prior to the reporting period. However, this claim would be included in the CY 2014 payment decision data if it was submitted by the submission deadline in April 2013.

Data for structural measures relates to all ASC patients (Medicare and non-Medicare).

Claims-based Measures
ASCs are to submit information on the five claims-based measures using Quality Data Codes (QDCs) entered on their claims submitted using the CMS-1500 or associated electronic dataset. QDCs are specified CPT Category II codes or Level II G-codes that describe the clinical action evaluated by the measure. Clinical actions can apply to more than one condition and therefore, can also apply to more than one measure. Facilities should review all reporting instructions carefully.

The appropriate QDC(s) are to be reported for all Medicare Part B fee-for-service patients, in addition to any codes that would be standard for billing purposes (e.g., the ICD-9-CM diagnosis and Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) Level II and CPT Category III codes for the services performed) on the ASC claim for the encounter.

Structural Measures
Data for structural measures are to be submitted using a web-based tool that will be located on the QualityNet website located at www.QualityNet.org. Data collection for structural measures is required in 2013, and the tool will be available at this time for data entry.

For questions regarding Medicare Quality Reporting for Ambulatory Surgery Centers contact Yvonda Moore at yvonda.moore@mixed-throne.flywheelsites.com.

 

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