Ambulatory Surgical Center Quality Reporting Program Support - PDF document

Ambulatory Surgical Center Quality Reporting Program Support Contractor Staying the Course: Sailing Toward Quality Reporting Success Presentation Transcript Moderator: Pam Harris, BSN, RN Project Coordinator, Education and Support Contractor Speaker(s): Karen VanBourgondien, BSN, RN Education Coordinator, Education and Support Contractor March 22, 2017 2:00 PM Karen VanBourgondien : Good afternoon everyone. Welcome to the Ambulatory Surgical Center Quality Reporting Program Webinar. Thank you for joining us today. My name is Karen VanBourgondien, an Education Coordinator for the ASC Program. If you have not yet downloaded today’s hand -outs, you can get them from our website at qualityreportingcenter.com. Just click on today’s event and you should be able to download those hand-outs. They are also attached to your ReadyTalk invite that you received for this webinar. Today’s speaker is Laurie Ciannamea, a Project Coordinator with the ASC Program. Laurie has an extensive background in healthcare, and has been with this program since its inception. Before we get started today, let me just make a couple of announcements. When you are using the question and answer tool, please remember to not submit any PII, which is Personally Identifiable Information, or PHI, Protected Health Information. On that platform, we can’t accept that type of information, and if you enter a question with that type of information it will automati cally be deleted and we won’t be able to respond to your question. So, examples of PI I and PHI are patients’ names, HIC numbers, medical record numbers, or any other unique identifying number code or characteristics. So just keep that in mind. Please join us on April 26, we will be discussing tools and resources that are available to you to optimise your reporting for this program. Any Page 1 of 13

Ambulatory Surgical Center Quality Reporting Program Support Contractor additional information regarding program updates or educational opportunities will be sent via ListServe. I f you’re not signed up for ListServe, it’s an automatic email service. We highly recommend that you sign up for that and you can do on the homepage of QualityNet. The learning objectives of this program are listed here on this slide. This program is bei ng recorded, and a transcript of today’s presentation, including the questions and answers received in the chat box, and the audio portion of today’s program will be posted on our website at qualityreportingcenter.com at a later date. During the presentation, as stated earlier, if you have a question, please put that question in the chat box that’s located on the left side of your screen, and one of our subject matter experts will respond. And we hope that by having live chat we can respond and accommodate your questions in a timely manner. So, without any further delay, let me turn things over to our speaker, Laurie Ciannamea, Laurie? Thanks, Karen. Hello, everyone, we’re so glad you were able to join us Laurie Ciannamea: for today’s webinar. To begin today’s presentation; let’s briefly touch on what’s required in order to meet the requirements of the Ambulatory Surgery Centre Quality Reporting Program, or ASCQR. This slide displays a direct quote from the Code of Federal Regulations or CFR, in which CMS defines the claims threshold that mandates a facility to participate or be subject to a 2% reduction in annual payment update. Okay, that’s fine but, you ask, what does that really mean? By way of an answer, let me give you an example: a facility had 200 claims in 2015, affecting payment year 2017. Because they fell below the 240 case threshold in 2015, they would not be required to report 2016 encounter data in 2017, which would im pact payment year 2018. It is the facility’s responsibility to monitor claims volume to ensure that they report data if they exceed the 240-case threshold for any given payment year. ASC-12 is an outcome measure that calculates a facility level rate of risk- standardised, all-cause, unplanned hospital visits within seven days of an outpatient colonoscopy, among Medicare Fee-for-Service patients aged 65 and older. Data collection begins with claims submitted in 2016 to affect payment determination beginning 2018. The data, which is facility specific, is being collected by CMS directly from the facility’s Me dicare Fee-for-Service claims. This means that the facility does not need to extract data or submit any data separately from its claims. No additional action is required by the facility to meet this measure. Page 2 of 13

Ambulatory Surgical Center Quality Reporting Program Support Contractor Let’s continue by discussing the five m easures, as listed on this slide, that the facility reports on its claims using Quality Data Codes or QDCs. Later on, we’ll discuss QDCs in grea ter detail. Using QDCs, the facility describes the patient ’ s experience at the ASC and whether or not the patient experienced any adverse events from measures ASC-1 to ASC-4. For ASC-5, the QDC defines whether or not there was an order for Prophylactic IV Antibiotic and whether or not it was administered timely. To be compliant with program requirements, facilities must report QDCs on at least 50% of the claims submitted to Medicare for payment in a given calendar year. So, we’ve talked about using QDCs to report on ASC-1 through ASC-5, but what are QDCs anyway? Let me try to explain. Quality Data Codes are specialised, non-reimbursed CPT codes that provide information about ASC performance and patient outcomes. QDCs are reported via Medicare Fee-for-Service claims, either primary or secondary, and including Medicare Railroad claims. They are not reported on Medicare Advantage, HMO Replacement, or any commercial care claim. They are non-payable procedure codes. The Quality Data Codes, or G-codes, were implemented by CMS to track the rate of occurrence of adverse outcomes within the ASC environment to better determine the relevance of these issues. So, for every Medicare Part B, Fee-for-Service, Medicare Railroad Retirement Board, and Medicare Secondary Payer claim that is submitted for payment, you must provide corresponding G- codes. This is how you provide valuable data on your facility’s outcomes and processes. Now, let me share a few helpful hints to help you ensure that your QDCs are accepted and that you receive credit for reporting. Each Medicare Fee- for-Service claim, primary or secondary, submitted for payment should have a minimum of two and a maximum of five QDCs applied to the claim upon submission. If there is only one QDC on the claim, for example, you will not get credit for QDC reporting on that particular claim. There is no means by which to add or change QDCs once the claim has been processed for payment. So, be sure that they are correctly entered on the claim when you initially submit it to CMS. Each page of the claim should have at least one billable charge and the QDCs on it. So, if the claim has numerous procedure codes, and rolls onto multiple pages, be certain to include the QDCs on each page. Similarly, if a claim requires more than one Form CMS-1500 version 02/12, such as the 7 th or 13 th line item, these line items will automatically go onto another claim to which QDCs must be added. Also, you do not want to submit the Page 3 of 13