Ambulatory Surgical Center Assessment (ASCA)

Also see the Department of Revenue's Ambulatory Surgical Center Assessment web page.

  1. What is the ambulatory surgical center assessment?
  2. What is the effective date of the assessment?
  3. Who is the assessment imposed on, and when is it due?
  4. Do I need to register with the Department of Revenue for the Ambulatory Surgical Center Assessment, and how do I register?
  5. How will the assessment amount be computed?
  6. How will an ambulatory surgical center (ASC) be notified of the amount of their assessment?
  7. Can an ambulatory surgical center appeal the assessment?
  8. Will medical assistance (MA) payments increase as a result of the assessment?
  9. Are the increased MA access payments considered gross patient revenue?
  10. What information must be reported to the Department of Revenue, and when is it due?
  11. Is the ASC assessment deductible for federal and state income tax purposes?
  12. Can an ambulatory surgical center file an amended survey?
  13. What happens if an ambulatory surgical center does not file the survey, or pay the assessment by the due dates?
  14. What is the definition of "gross patient revenue"?
  15. What is the definition of "total patient charges"?
  16. What is the definition of "patient services"?
  17. What is the definition of "bad debt expense"?
  18. What is the definition of "cash basis"?
  19. What is the definition of "charity care"?
  20. What is the definition of "payer discounts"?
  21. What is the definition of "refunds"?

  1. What is the ambulatory surgical center assessment?

    The ambulatory surgical center assessment is an assessment imposed by the State of Wisconsin in proportion to the gross patient revenue of ambulatory surgical centers located in Wisconsin participating in the federal Medicare program. Pursuant to section 146.98, Wis. Stats., the Department of Revenue (DOR) imposes and collects the assessment. See sec. 146.98, Wis. Stats., at: http://nxt.legis.state.wi.us/nxt/gateway.dll?f=templates&fn=default.htm&d=stats&jd=146.98. Assessments imposed in compliance with federal law (42 C.F.R. ยง433.68) allow the State to collect additional federal matching funds for the medical assistance program which provides health care services to people with limited resources. Medical assistance is also commonly referred to as Medicaid, or Title XIX of the Social Security Act.

  2. What is the effective date of the assessment?

    The ambulatory surgical center assessment is effective July 1, 2009, pursuant to 2009 Wis. Act 28. The assessment continues for the state's fiscal year 2012 and fiscal year 2013 pursuant to 2011 Wis. Act 32 and continues in fiscal year 2014 and fiscal year 2015 pursuant to 2013 Wis. Act 20.

  3. Who is the assessment imposed on, and when is it due?

    The ambulatory surgical center assessment is imposed on ambulatory surgical centers certified by the federal Centers for Medicare & Medicaid Services (CMS) to participate in Medicare as an ambulatory surgical center (ASC). A provider directory of ambulatory surgical centers in Wisconsin can be found at: http://www.dhs.wisconsin.gov/guide/ascdir.pdf

    The ASC assessment for state fiscal year 2014 is due on or before June 2, 2014. The ASC assessment for state fiscal year 2014 will be calculated from calendar year 2013 gross patient revenue data filed by ASCs on or before March 17, 2014. DOR will post fiscal year 2014 ASC assessment amounts on My Tax Account beginning April 15, 2014. Failure to pay the assessment shall result in a penalty of $500 per day calculated from the day after the June 2, 2014 due date up to the date the assessment is received by the Department of Revenue (DOR).

  4. Do I need to register with the Department of Revenue for the Ambulatory Surgical Center Assessment, and how do I register?

    Ambulatory surgical centers meeting the requirements for participation in the federal Medicare program (Title XVIII of the Social Security Act) are required to register with the Wisconsin Department of Revenue. You should include a copy of your Notice of Certification from the Centers for Medicare & Medicaid Services when registering with the Department of Revenue.

    To register an ambulatory surgical center:

    • Send an email requesting an ASCA account to dorregistration@revenue.wi.gov, or
    • Write a letter requesting an ASCA account and mail to Wisconsin Department of Revenue, ATTN: Registration Unit, PO Box 8902, Madison WI 53708-8902.
  5. How will the assessment amount be computed?

    The statute creating the ambulatory surgical center assessment (section 146.98, Wis. Stats.), did not set a statutory rate for the assessment. Rather the statute directs the Department of Revenue (DOR) to impose the assessment among ambulatory surgical centers (ASC's) in proportion to their gross patient revenue, and satisfying the requirements in federal law under 42 CFR 433.68 for collecting an assessment without incurring a reduction in federal financial participation under the federal Medicaid program.

    The requirements in federal law that DOR must satisfy in imposing the assessment are that the assessment is broad based, that the assessment is uniformly imposed throughout a jurisdiction, and that the assessment rate does not exceed 5.5% as measured on an annual state fiscal year. As required in 2009 Wis. Act 28, the ASC assessment is effective with the start of the 2010 state fiscal year (July 1, 2009). The Act imposing the ASC assessment included a revenue target for ASC assessments for each fiscal year of the state's 2009-2011 biennial budget (fiscal year 2010 and fiscal year 2011). The assessment continued in fiscal year 2012 and fiscal year 2013, pursuant to 2011 Wis. Act 32, and continues in fiscal year 2014 and fiscal year 2015 pursuant to 2013 Wis. Act 20. DOR is directed to transfer $16,700,000 to the state Medical Assistance trust fund for each of the fiscal years 2012, 2013, 2014 and 2015. Section Tax 1.17 of the Wisconsin Administrative Code requires ASC's to electronically file an annual gross patient revenue survey on or before March 15 (or the next business day). See revenue.wi.gov/html/ascafinord.pdf. ASC's will report gross patient revenue data for the period January 1, 2013 through December 31, 2013 on or before March 17, 2014. The department will compute the assessment using the total revenue target established in 2013 Wis. Act 20 divided by the total amount of gross patient revenue reported by all ASC's for the year.

    Ambulatory Surgical Center Assessment Rate  
    Revenue Target - FY 2013
    Total Gross Patient Revenue reported by all ASC's in calendar year 2012
    $16,700,000
    $418,489,270
    Assessment Rate - FY 2013 3.9905%
       
    Your ASC Assessment  
    Your Gross Patient Revenue in calendar year 2012
    Assessment Rate - FY 2013
    $18,013,170
    3.9905%
    Total Amount Due $718,816

    Based on the gross patient revenue reported by all ASCs in calendar year 2009, the fiscal year 2010 assessment rate was 4.6191%; based on the gross patient revenue reported in calendar year 2010, the fiscal year 2011 assessment rate was 4.3789%; based on the gross patient revenue reported in calendar year 2011, the fiscal year 2012 assessment rate was 4.1798; and based on the gross patient revenue reported in calendar year 2012, the fiscal year 2013 assessment rate was 3.9905%.

    Note: The fiscal year 2014 rate will be calculated after ASCs report their calendar year 2013 gross patient revenues.

  6. How will an ambulatory surgical center (ASC) be notified of the amount of their assessment?

    Notice of the amount of the fiscal year 2014 ambulatory surgical center assessment (ASCA) will be posted by the Department of Revenue (DOR) on My Tax Account (MTA), DOR's electronic business tax service beginning April 15, 2014. Each ASC will be able to find their ASCA on My Tax Account. An ASC will log into MTA, click on the ambulatory surgical center account ID link, and then view the "Period Ending Balance" information near the bottom of the screen.

  7. Can an ambulatory surgical center (ASC) appeal the assessment?

    Yes, ambulatory surgical centers (ASCs) claiming to be adversely affected by the Department of Revenue's (DOR's) actions may petition DOR for a contested case hearing under sec. 227.42, Wis. Stats.

    Requests for hearing shall be in writing and mailed to the Secretary of Revenue within 30 days after DOR's actions.

    Written requests should be addressed to Wisconsin Department of Revenue, Office of the Secretary, PO Box 8933, Madison, WI 53708.

    Appeals will be considered timely filed if:

    • The appeal is mailed in a properly addressed envelope with the postage duly prepaid.
    • The envelope containing the appeal is postmarked on or before 30 days after the department's notice of assessment.
    • The appeal is postmarked on or before the due date specified above and is received by the department within five days of the due date.
  8. Will medical assistance (MA) payments increase as a result of the assessment?

    Yes, Act 28, Act 32 and Act 20 authorize increasing MA payments to ambulatory surgical centers (ASCs) with a portion of the assessment revenue and the associated federal matching funds obtained by the State. The Department of Health Services will notify ASCs of the amount of additional MA funding. Questions regarding MA reimbursement should be directed to the Bureau of Fiscal Management, Division of Health Care Access and Accountability, Department of Health Services, 1 W. Wilson Street, Room 350, PO Box 309, Madison, WI 53701-0309, telephone (608) 266-2469.

  9. Are the increased MA access payments considered gross patient revenue?

    Yes, "gross patient revenue" is the gross amount received on a cash basis by the provider from all patient services. MA access payments are payments for patient services received by the ASC on a cash basis, and should be included in the annual survey of gross patient revenue.

  10. What information must be reported to the Department of Revenue, and when is it due?

    Ambulatory surgical centers (ASCs) must report gross patient revenue, total patient charges, bad debt expense, charity care, payer discounts, and payer refunds. Using the department's electronic tax service, My Tax Account (MTA), ASC survey information for the period January 1, 2013, through December 31, 2013 must be filed by March 17, 2014.

    ASCs may apply for a 5 calendar day extension of the survey due date. Applications for extension must be filed electronically through My Tax Account. The ASC must log into MTA, click on the ambulatory surgical center account ID link, and then click on the Request Extension to File link. Extensions will be granted for good cause only. Failure to file the survey during the period of the extension shall make the extension null and void, and result in a late filing penalty.

  11. Is the ASC assessment deductible for federal and state income tax purposes?

    Yes, the ambulatory surgical center assessment is deductible for federal income tax purposes under sec. 164(a) of the Internal Revenue Code. There is no provision in Wisconsin law that requires the amount of the federal deduction under sec. 164(a) to be added back to federal income when determining Wisconsin taxable income. Therefore, the amount of the federal deduction will automatically carry over to the Wisconsin return and be allowed for Wisconsin. Specific questions regarding the deductibility of the assessment for federal income tax purposes should be directed to the Internal Revenue Service.

  12. Can an ambulatory surgical center (ASC) file an amended survey?

    Yes, ambulatory surgical centers (ASCs) may amend their calendar year 2013 survey data through April 1, 2014. Amendments should be made on the ASC assessment (ASCA) survey found on My Tax Account.

    After April 1, 2014, the Department of Revenue will calculate the fiscal year 2014 assessment based on the amount of gross patient revenue reported on the annual survey. Amended surveys will not be accepted after April 1, 2014.

  13. What happens if an ambulatory surgical center (ASC) does not file the survey, or pay the assessment by the due dates?

    If an ASC fails to file the survey by the March 17, 2014 due date or March 22, 2014 extended due date, the Department of Revenue (DOR) shall calculate an assessment based upon information submitted by ASCs for the prior year, and any other information in DOR's possession and according to its best judgment. In addition, DOR may impose a penalty of 25% of the amount of the assessment if the ASC fails to file the survey by the due date.

    Failure to file the survey by the due date, including any extension shall result in a late filing penalty of $500 per day calculated from the day after the unextended due date up to the date the completed survey is received by DOR, or April 1, whichever is earlier.

    Failure to pay the assessment by June 2, 2014 shall result in a penalty of $500 per day subject to a maximum penalty equal to the amount of the assessment. If a written letter of appeal has been received by the department, the $500 per day penalty will be suspended during the pendency of an appeal. If an appeal is denied, the $500 per day penalty will be assessed beginning with the day after the June 2, 2014 due date up to the date the assessment is received by the Department of Revenue. If an appeal is successful, the revised assessment will be due 30 days from the date of the appeal redetermination notice. Late payment penalties will not be assessed if payment is received by the department on or before the payment due date.

  14. What is the definition of "gross patient revenue"?

    "Gross patient revenue" is the gross amount received on a cash basis by the provider from all patient services.

  15. What is the definition of "total patient charges"?

    "Total patient charges" means the charges related to patient services at the ambulatory surgical center's established undiscounted rates, and consistent with the health care information required to be reported in sec. 153.05 (1) (b), Wis. Stats.

  16. What is the definition of "patient services"?

    "Patient services" include any of the following goods and services provided to a patient or consumer:

    • Bed and board;
    • Nursing services and other related services;
    • Use of the ambulatory surgical center;
    • Medical social services;
    • Drugs, biologicals, supplies, appliances and equipment;
    • Other diagnostic or therapeutic items or services;
    • Medical or surgical services;
    • Laboratory services;
    • Items and services furnished to ambulatory patients not requiring emergency care;
    • Emergency services including ambulance services.
  17. What is the definition of "bad debt expense"?

    "Bad debt expense" is the provision for actual or expected uncollectible expenses resulting from the extension of credit.

  18. What is the definition of "cash basis"?

    "Cash basis" is the method of accounting where the income is generally reported in the year that it is actually or constructively received in the form of cash or its equivalent or other property.

  19. What is the definition of "charity care"?

    "Charity care" is health services that were never expected to result in cash inflows. It results from an ambulatory surgical center's policy to provide health care services free of charge to individuals who meet certain financial criteria.

  20. What is the definition of "payer discounts"?

    "Payer discounts" are an agreed upon reimbursement to supply services for a fee that is discounted from the ambulatory surgical center's usual and customary charges. This may be a fixed amount per service, or a percentage discount.

  21. What is the definition of "refunds"?

    "Refunds" are funds actually returned to a payer either through cash, or through a recoupment because of an over collection by the payee.

FOR MORE INFORMATION PLEASE CONTACT:

WISCONSIN DEPARTMENT OF REVENUE
Customer Service Bureau
PO Box 8949, MS 5-77
Madison, WI 53708-8949
Phone: (608) 261-5338
Fax: (608) 267-1030
Email additional questions to DORMyTaxAccountHelp@revenue.wi.gov

February 21, 2014