CMS Releases Supporting Information on Prior Authorization Demonstration Project

The Centers for Medicare & Medicaid Services (CMS) recently released Supporting Statement Part B, which provides more information on the proposed prior authorization demonstration project for ASCs. The supporting information includes the states impacted, which are: Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee and Texas. It also includes the specific codes that would be subject to the demonstration, which fall within the following categories:

• Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair
• Botulinum Toxin Injection
• Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy), and related services
• Rhinoplasty, and related services
• Vein Ablation, and related services

As ASCA reported last week, CMS announced that it “seeks to develop and implement a Medicare demonstration project, which CMS believes will assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring in ambulatory surgical centers providing services to Medicare beneficiaries.” ASC providers would have to submit documentation to their Medicare Administrative Contractors (MAC) that shows a service meets applicable Medicare coverage, coding, and payment rules prior to rendering the service.

ASCA staff reached out to the contact on the demonstration notice to ask who the responsibility falls on since the notice refers several times to “ASC providers.” The email ASCA received in response states, “The physician needs to submit the prior authorization request or materials requested by the MAC for preclaim review and that drives the process.”

ASCA Submits Codes for Consideration for Addition to ASC-CPL

ASCA submitted codes by the March 1 deadline in response to the ASC Covered Procedures List (ASC-CPL) Pre-Proposed Rule Recommendation Request. This is a new way to submit codes for consideration that the Centers for Medicare & Medicaid Services (CMS) rolled out this year. Based on feedback from members, including our new cardiovascular working group, ASCA submitted the following:

a.       Cardiovascular codes: Electrophysiology Studies and Ablations: 93613, 93619, 93620, 93623, 93650, 93653, 93654, 93655, 93656, and 93657 Peripheral Vascular – Diagnostic: 75630, 75710, 75716, and 75736 Cardioversion and TransEsophageal Echocardiogram: 92960 and 93355

b.       Spine codes: (Posterior Lumbar Inter-body Fusion (22630) and Combined Posterior Lumbar and Posterior Lumbar Inter-body Fusion (22633)

Federal Legislative Update

After meeting with participants during National Advocacy Day, Representatives Joe Wilson (R-SC), Kevin Kiley (R-CA), Tracey Mann (R-KS) and Jefferson Van Drew (R-NJ) joined the Outpatient Surgery Quality and Access Act of 2023 as cosponsors. A full list of cosponsors is available for the US House of Representatives and Senate. You can help gain further support for the bill by using ASCA’s template letter to reach out to your lawmakers and ask them to sign on to the bill as a cosponsor. Thank you to everyone who participated in this year’s fly-in and for garnering more ASC supporters in Congress!

Change Healthcare Cybersecurity Issue Resources

On March 5, the US Department of Health & Human Services (HHS) released a statement regarding the Change Healthcare cybersecurity attack, which included some flexibilities available to impacted healthcare providers. Of note, the Centers for Medicare & Medicaid Services (CMS) has authorized accelerated payments, similar to what was available during the COVID-19 public health emergency.

In the statement, HHS indicates that “during outages arising from this event — facilities may submit accelerated payment requests to their respective servicing MACs for individual consideration. We are working to provide additional information to the MACs about the specific items and information a provider’s request should contain. Specific information will be available from the MACs later this week.”

ASCA has created a page with tools to help ASCs respond to cybersecurity issues and information regarding the Change Healthcare cybersecurity attack.