Regulatory Resources

Take advantage of these resources to learn about and prepare for regulations that can affect your practice operations and the delivery of GI care. 

Medicare Physician Payment

The Medicare physician payment fee schedule determines the reimbursement rates for all Medicare Part B Services.  Every summer, CMS releases a proposed rule regarding the upcoming year's physician payment schedule.  In this proposed rule, CMS proposes relative Value Units (RVUs) for the upcoming year, updates to geographic practice cost indexes and changes to other Medicare Part B payment policies. The proposed rule also details changes and updates to the new Quality Payment Program. The physician payment fee schedule final rule is published in late fall. 

ASC Payment System

The ASC is an important part of the practice of gastroenterology, providing a safe, patient friendly and cost effective environment for the provision of medical services. About 40 percent of all colonoscopies are provided in ASCs and the majority of ASCs, in which gastroenterologist practice, are single specialty centers. Because of their single specialty structure, gastrointestinal ASCs are particularly sensitive to changes in Medicare payments. Medicare reimbursement for gastrointestinal services, provided in the ASC setting, have been declining causing a widening disparity between payment rates for ASCs and the hospital outpatient departments (HOPDs). 

Quality Payment Program

With the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA), the Medicare Sustainable Growth Rate formula was repealed and replaced with the Quality Payment Program (QPP).  Eligible clinicians can participate in the QPP via one of two pathways: the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). MIPS and APMs will drive physician payment for Medicare starting in 2019 with 2017 reporting. Proper and fair implementation of MACRA is a priority for ASGE.  The ASGE MACRA Implementation Resource Center will provide members with the resources and tools needed to transition to the new Medicare physician payment system. 

ICD-10  

The updated ICD-10-CM system consist of codes that use 3-7 digits instead of 3-5 digits to be used in all U.S. health care settings. ICD-10 replaced a 30 year old system that has outdated terms and is limited in potential for new codes. 

Quality Programs

CMS has a host of quality programs related to physician and facility quality improvement initiatives.  Starting with 2017 reporting, the Physician Quality Reporting System, Value-Based Payment Modifier, and the EHR Incentive Payment Program will merge together to form the Merit-Based Incentive Payment System.