Program Information

The ASC Quality Reporting (ASCQR) Program is a quality measure data reporting program implemented by the Centers for Medicare & Medicaid Services for care provided in the ASC setting. The ASCQR Program exists to promote higher quality, more efficient health care for Medicare beneficiaries through data reporting, quality improvement, and measure alignment with other clinical care settings.

ASCs that meet program requirements during a given calendar year (CY) receive their full payment update for the upcoming CY; ASCs that do not participate or fail to meet those requirements may receive a two percent reduction of their payment update. To participate in the program, an ASC submits quality measure data; once an ASC submits any quality measure data under the ASCQR Program, the ASC is considered to be participating in the program.

Payment Determinations

CY 2017

The CY 2017 payment determinations will be based on Quality Data Codes (QDCs) submitted on Medicare Fee-for-Service claims with dates of service from January 1, 2015 through December 31, 2015, that are received in the Medicare Claims Warehouse by April 30, 2016. The minimum threshold for successful reporting is that at least 50 percent of Medicare claims meeting measure specifications contain the appropriate QDCs.

The submission of web-based measures ASC-6, -7, -9, and -10, with reference to the clinical encounter time period of CY 2015 is also a program requirement. ASC-11 is a voluntary measure; any numeric value submitted will be publicly reported. The deadline for submitting these measures is August 15, 2016.

ASCs will report data for ASC-8 to the National Healthcare Safety Network (NHSN) for the influenza season of October 1, 2015 through March 31, 2016. Facilities must register and create an account at http://www.cdc.gov/nhsn. The submission period extends from October 1, 2015 through May 15, 2016.

Measures

Quality Data Codes

QDCs are specified CPT Category II codes or Level II G-codes that describe the presence or absence of an event. One QDC is to be present for each relevant measure. Medicare claims submitted must have a minimum of two QDCs. To ensure compliance with program requirements, claims submitted to Medicare must include the appropriate codes.

Please see this chart to determine which QDCs to use for the five claims-based ASC Quality Measures.

Web-Based Measures

Aggregate data for web-based measures are submitted to CMS or to the NHSN. Measures ASC-6, -7, -9, and -10 are answered via the QualityNet Secure Portal, and ASC-8 is reported to the NHSN. To submit web-based measure data and access reports, ASCs must have an active Security Administrator registered with QualityNet.

ASC-11 is a voluntary measure; any data submitted will be publicly reported.

More detailed information on program requirements and measures can be found in the ASCQR Program Reference Checklist and on QualityNet.

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