Wiki Recently passed Federal Budget will tweak/adjust Medicare Physician Fee Schedule

[ellzeycoding]

We put together this article on the recently passed 2018 Federal Budget and how it will positively impact 2018 Fee Schedules for Medicare providers in 53 of the 112 Medicare Localities

The Medicare Contractors have been relatively mum about this change and it is not yet clear how they will handle claims already submitted/paid and claims that are currently in queue. Only one MAC has released information.

This story is still developing...

BREAKING ALERT - Federal Budget tweaks 2018 Physician Fee Schedule for multiple Medicare carriers

 

[CodingKing]

Oh god, thanks for posting this. I work for a MA plan and I'm about to update 100+ fee schedules with the GPCI adjusted 2018 RVUs. You just saved me a ton of rework.

 

[ellzeycoding]

UPDATE as of 02/28/2018

1. I have confirmed with CMS sources that the Work GPCI issue as discussed below will be retroactive to 01/01/2018.

2. Medicare Contractor Updates...

WPS Medicare - has posted information on their website (see original link below)
Noridian - has updated their fee schedules, but there is no explanation on their website of how they will reprocess previously paid claims
Palmetto GBA - has updated their fee schedules, but there is no explanation on their website of how they will reprocess previously paid claims
Novitas - has updated their fee schedules, but there is no explanation on their website of how they will reprocess previously paid claims
First Coast Services - has updated their fee schedules, but there is no explanation on their website of how they will reprocess previously paid claims
CGS Medicare - has updated their fee schedules, but there is no explanation on their website of how they will reprocess previously paid claims


3. On 2/28/2018 - CMS released an updated summary today which has this tidbit...

"For Sections 50201 “Extension of Work Geographic Practice Cost Index (GPCI) Floor”, 50202 “Repeal of
Medicare Payment Cap for Therapy Services; Limitation to Ensure Appropriate Therapy”, and 50203
“Medicare Ambulance Services” provision changes, Medicare Administrative Contractors (MAC) will
implement these changes no later than February 26, 2018, and will provide additional details on
timelines for reprocessing or release of held claims impacted by these changes. The following are
brief descriptions of these provisions:"

Section 50201 - Extension of Work Geographic Practice Cost Index (GPCI) Floor - The new law
extends a provision raising the Work GPCI to 1.000 for all localities that currently have a Work
GPCI of less than 1.000. The Work GPCI Floor impacts the fees for all codes paid under the
Medicare Physician Fee Schedule (MPFS) for those localities. The Work GPCI floor is extended
through December 31, 2019. No new provider action is necessary for implementation.

Source: https://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers/Downloads/Medicare-Expired-Legislative-Provisions-Extended.pdf


4. Our last bit of advice is UPDATE Your Fee Schedule to these new rates!!! If you continue to underbill, you may get underpaid.


I have updated the original article above in my original post...