HCFA announces new ASC pay rates

Medicare payment rates for ambulatory surgery centers (ASCs) inched up by 2.6% beginning Oct. 1. The inflation adjustment effectively raises ASC rates across the board for the eight existing payment levels that the Health Care Financing Administration uses to reimburse freestanding same-day surgery facilities.

The newly-adjusted rates have increased to the following:

Group 1 $312

Group 2 $419

Group 3 $479

Group 4 $591

Group 5 $674

Group 6 $785

Group 7 $935

Group 8 $923 *

HCFA clarifies definition of hospital-based facility

Officials at the Health Care Financing Administration (HCFA) are clarifying the way an outpatient facility is defined by Medicare for payment purposes.

Eight criteria determine whether an outpatient center -- freestanding or not-- is considered hospital-based. The facility should:

* be physically located in proximity to the hospital and serve the same patient population;

* form an integral and subordinate part of the hospital and operate with other departments under the same licensure;

* share the same accreditation with the hospital;

* come under the same daily supervision of the hospital's management;

* be recognized by the public as part of the hospital;

* have clinical services that are integrated with the hospital;

* share a common ownership and governance;

* be financially integrated.

"You don't have to meet all the criteria, but virtually all the criteria," says Charles Booth, director of hospital policy at the Health Care Financing Administration. "You must show that the facility really is integrated with the hospital in terms of financial records, medical records, and reporting."

Many hospitals have expressed concern about whether a facility must be located on the hospital campus to be defined as a hospital-based outpatient center. The answer is no, says Booth, who adds that there is no set distance requirement either.

"If you meet all those [other] criteria, then distance isn't quite such an issue," he says.

[Editor's note: For more information on the definition of a hospital-based outpatient facility, contact Charles Booth, Director of Hospital Policy, Health Care Financing Administration, Room C5-02-23, 7500 Security Blvd., Baltimore, MD 21244. Telephone: (410) 786-4487. Fax: (410) 786-0594. E-mail: cbooth@hcfa.gov.] *