HCFA proposes new ASC Medicare criteria coverage

As promised, the Health Care Financing Administration (HCFA) has released a draft of preliminary changes to the conditions of Medicare coverage for ambulatory surgery centers (ASCs).

The report comes nine months after a town meeting between HCFA and the ASC industry in which the government proposed significant changes to the way HCFA will pay for ASC services, including the possible use of ambulatory patient groups.

The draft adds new requirements and expands existing criteria ASCs would have to meet to comply with Medicare regulations. Under the proposals, surgeons’ operative reports contained in the patient record must explicitly document clinical complications, patient reactions following surgery, the length of time of the surgery, and the techniques used.

In general, the changes are designed to be more outcomes oriented while shifting the burden of proof for coverage onto the provider, says Terri Harris, a HCFA representative. "The overall message to ASCs is ‘you guys will have to demonstrate to us whether you’re meeting standards,’" Harris says.

Getting Control: Effective Procedure Coding for Emergency Medicine, April 4-6, The Hyatt Regency Baltimore. Sponsored by the American College of Emergency Physicians (ACEP). Contact: ACEP Sales and Services, P.O. Box 619911, Dallas, TX 75261-9911. Telephone: (800) 798-1822, ext. 6. Fax: (972) 580-2816. E-mail: meetingregistrar@acep.org.

• Toward An Electronic Patient Record, 13th International Symposium, April 29-May 3, Oryland Hotel Convention Center, Nashville, TN. Contact: Medical Records Institute, 567 Walnut St., Newton, MA 02160. Telephone: (617) 964-3923. Fax: (617) 964-3926. E-mail: cust_service@medrecinst.com.

• Coding for Ambulatory Surgery Seminar, May 7, Boston Marriott Copley Place Hotel. Contact: Federated Ambulatory Surgery Association, 700 N. Fairfax St., Suite 306, Alexandria, VA. 22314. Telephone: (703) 836-8808.