Medicare Compliance & Reimbursement

Conversion factor for 2015 already changed.

The Centers for Medicare & Medicaid Services (CMS) has good and bad news for you. Despite the fact that CMS published the Medicare Physician Fee Schedule Final Rule in November, the agency found several technical errors in the document and, as a result, all MACs are holding 2015 claims for the first two weeks of the year.

“On Nov. 13, the 2015 Medicare Physician Fee Schedule Final Rule was published in the Federal Register,” said CMS’s Louisa Rink during a Jan. 7 CMS Open Door Forum. However, she said, in order to implement corrections to technical errors discovered after the publication of the rule and to process claims correctly, CMS has asked MACs to hold all claims with dates of service Jan. 1 through Jan. 14. In addition, you won’t have access to the specific 2015 payment amounts until later this month.

Don’t Panic

Although a two week-hold may sound startling at first, the reality is that it shouldn’t upset your payments too severely. “The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt,” Rink said.

Fortunately, this won’t impact your payments for 2014 dates of service. “Medicare Physician Fee Schedule claims for services rendered on or before Wednesday, Dec. 31, 2014 are unaffected by the 2015 claims hold and will be processed and paid under normal procedures and time frames,” Rink added.

New Conversion Factor to Debut

One of the issues with the Fee Schedule published Nov. 30 appears to have been an error in the conversion factor, said CMS’s Kathy Bryant during the Jan. 7 Open Door Forum. “The conversion factor that is in the new payment files is slightly lower than the conversion factor in the Final Rule,” she said. “It is 35.7547, which is a change of .0466, and we anticipate that we will be releasing a correction notice that will detail the exact nature of the corrections that have been made.”

This change, of course, will only impact the conversion factor through March 31. Starting April 1, you’ll be looking at a conversion factor cut of 21 percent (down to $28.2239) through the end of 2015 unless Congress votes to reverse the cut.