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Reimbursement Issues

ASTS educates and advocates the Centers for Medicare and Medicaid Services (CMS) concerning coverage decisions for organ systems and immunosuppressive drugs, the Physician Fee Schedule (PFS), the Inpatient Prospective Payment System (IPPS), which includes changes to the Diagnosis Related Groups (DRGs), and other reimbursement issues that impact ASTS members. ASTS works with the American Medical Association and the American College of Surgeons through its Relative Value Update Committee (RUC) process to recommend new Coding Procedural Terminology (CPT) and update relative values for CPT codes. The ASTS Council, committees and task forces work with reimbursement counsel to provide education and recommendations.

ICD-10 Resources

For recent developments related to ICD-10 roll out and requirements, please refer to the CMS website for up-to-date information.

Tools to Help with Reimbursements

The Reimbursement Committee has released a Professional Coding Guide and Major Complicating Co-Morbidities (MCC) Worksheet to help properly capture and document transplant-related MCC, Complicating Co-Morbidities, and Hospital Acquired Complications. The coding guide will help make sure you are properly compensated and receive Relative Value Unit credit for all the work you do, while the MCC Worksheet serves as a handy reference for commonly seen diagnoses related to transplantation.

CMS Center for Medicare and Medicaid Innovation (CMMI)

Use http://innovations.cms.gov/ to access the CMS Center for Medicare and Medicaid Innovation (CMMI) website. The website serves as the primary vehicle for submissions of proposed projects and information and updates on the CMMI process. CMMI is focused on three priorities for innovative ideas: 1) Patient Care Models, 2) Seamless and Coordinated Care Models, and 3) Community and Population Health Models.

Physician Quality Reporting System (PQRS) Resources

2012 PQRS Primer prepared by the ASTS Standards Committee 2012 PQRS Internal Billing Form Example prepared by the ASTS Standards Committee
2012 PQRS information provided by the Centers for Medicare & Medicaid Services (CMS)