Earlier this month I wrote an article that included a summary of the ancillary services packaging policy the Centers for Medicare and Medicaid Services (CMS) implemented in its 2015 Hospital Outpatient Prospective Payment/Ambulatory Surgical Center Payment Systems Final Rule.
That summary stated CMS had:
…finalized its proposal to package the technical component of select ancillary services, including many anatomic pathology services, into a single unified payment for services provided in hospital outpatient departments or free-standing ambulatory surgical centers (ASCs).
After I published the article, Jane Pine Wood, a specialist in health law and member of McDonald Hopkins, contacted me and said she thought the packaging policy did not apply to ASCs, as I had written, but was not entirely sure.
Since she was able to find passages within the Final Rule that seemingly supported both of our conclusions, Ms. Wood decided to contact CMS for clarification, and officials there were kind enough to promptly respond.
Those officials informed Ms. Wood the packaging policy only applied to surgical procedures performed in hospital outpatient departments and not those performed in free-standing ASCs. She was also referred to pages 66806 and 66923-66925 in Volume 79 of the Federal Register, which discuss this issue.
Page 66806
The commenters are correct that the comprehensive APC [ambulatory payment classification] payment policy methodology is not being adopted under the ASC payment system…This continuation of separate payment for covered procedures and covered ancillary services performed in the ASC…
Page 66925
Given the final OPPS comprehensive APC policy and after consideration of the public comments we received, we are finalizing our proposal that all separately paid covered ancillary services that are provided integral to covered surgical procedures that would map to comprehensive APCs will continue to be separately paid under the ASC payment system instead of being packaged into the payment for the comprehensive APC as under the OPPS.
In addition to those passages, I found this interesting part on page 66923:
Unlike the OPPS claims processing system that can be configured to make a single payment for the encounter-based comprehensive service whenever a HCPCS code that is assigned to a comprehensive APC appears on the claim, the ASC claims processing system does not allow for this type of conditional packaging.
This sounds to me as though CMS will not be able to institute a similar packaging policy for ASCs in the future without going to the trouble of fundamentally altering the ASC claims processing system. So we have that going for us.
Commentary
Obviously this is very good news for pathologists and laboratories, who now do not need to negotiate payment rates with ASCs for their services. That would have been a massive undertaking. Instead, we will only need to negotiate with hospitals that do not have a histology laboratory at all and those that have a histology lab but lack the ability to perform more advanced pathology services that are packaged, like flow cytometry, immunohistochemistry, FISH, etc.
I highlighted the difficulty Ms. Wood had with the packaging policy simply to demonstrate that even an expert in health law and health policy like Ms. Wood can find the interpretation of these rules to be a challenge.
Many, many thanks to Ms. Wood for clarifying this issue.
