Practice Management Alert

Stay tuned for changes in April.

For the first time in several years, your practice didn’t start the new year wondering if you’ll face double-digit pay cuts unless Congress came through with a save. But that doesn’t mean you can count on exactly the same reimbursement as last year.

Review the facts to learn where you stand with Medicare for 2015, beyond this first month of the year.

Conversion Factor Changes Only Slightly — For Now

Although PAMA promised a flat conversion factor (CF) through March 31, the Physician Fee Schedule (PFS) final rule actually defines a small decrease from the 2014 CF of $35.822 to $35.7547 for the period of Jan. 1 through March 31, 2015.

Note that the originally, CMS stated in the PFS that the CF for the first quarter of 2015 would be $35.8013. However, CMS re-released an updated version of the PFS with the $35.7547 rate.

The 0.13 percent reduction was triggered by “budget neutrality adjustments,” said Kathy Bryant, director of the division of practitioner services at CMS’ Hospital and Ambulatory Policy Group in a recent CMS Open Door Forum. “We anticipate we’ll be releasing a correction notice that will detail the exact nature of the corrections that have been made.”

Because of the adjustment, Medicare also implemented a 14-day claims hold for the beginning of the year. In a brief to providers, CMS explained the reasoning for the hold:

“On November 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 (i.e., Thursday January 1 through Wednesday January 14). 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. MPFS 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.”

Beware of Further Changes in Q2

If Congress does not act before April 1, 2015 to address the SGR formula or institute another temporary “patch,” the CF for Medicare payments will fall by more than 20 percent to $28.2239.

If Congressional tradition holds, that drastic cut will not occur, says Michael A. Granovsky, MD, FACEP, CPC, President of Logixhealth, a national coding and billing company based in Bedford, MA.

“We won’t know until we get closer to April, but it’s likely that Congress could just enact another patch at that time,” predicts Karen Ferguson, senior director of public policy for the American Medical Group Association (AMGA).

Possibility: The final rule gives some hope that a permanent SGR fix may be possible, because for five consecutive years, actual expenditures have been below budgeted allowed expenditures, which would lower the cost of a true SGR fix. That savings may make a permanent fix, rather than a patch, more acceptable to Congress, says Granovsky.