Tention Health Professionals: Information Regarding the 2015 Medicare Physician Fee Schedule

On April 1, 2015, the Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) methodology as required by current law. The SGR methodology required a 21% decrease in all MPFS payments beginning April 1, 2015. The Centers for Medicare & Medicaid Services (CMS) took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of service on and after April 1, 2015. Additionally, Medicare is also holding all therapy claims that would no longer qualify for the therapy cap exceptions (those therapy claims with the ‘KX’ modifier), due to the expiration of the therapy cap exceptions process on April 1, 2015.  In the absence of additional legislation to avert the negative update, CMS must update payment systems to comply with the law, and implement the negative update.

Beginning on April 15th, 2015, CMS will release held MPFS claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received.  CMS will release one day’s worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days’ worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This “rolling hold” will help minimize the number of claims requiring reprocessing should Congress pass legislation changing the negative update.

Providers should remember that claims for services furnished on or before March 31, 2015 are not affected by the payment cut and will be processed and paid under normal time frames.  We are working to limit any impact to Medicare providers and beneficiaries as much as possible. The MACs will automatically reprocess the claims paid at the reduced rate if Congressional action is taken to avert the negative update.  No action is necessary from providers who have already submitted claims for the impacted dates of service.

Informational Alert
Issued 4/15/2015 at 7:22 AM
Common Working File (CWF) Hosts will be Conducting History Purges
On Saturday, May 2, 2015, the CWF Northeast, Southwest, Southeast, Great Lakes, and Mid-Atlantic Hosts will be conducting a history archive.
On Saturday, May 9, 2015, the CWF South, Pacific, Great Western, and Keystone Hosts will be conducting a history archive.

Due to the anticipated duration of this activity and to ensure the completion of the weekly processing and scheduled data center maintenance, Saturday, May 2, 2015, will be a CWF Dark Day at the Northeast, Southwest, Southeast, Great Lakes, and Mid-Atlantic Hosts only. Saturday, May 9, 2015, will be a CWF Dark Day at the South, Pacific, Great Western, and Keystone Hosts only. This means there will be no access to the Health Insurance Master Record (HIMR) query, which is usually available until 12:00 p.m. (Eastern Standard Time) each Saturday.

All files received from satellites for Friday’s cycle (May 1, 2015 and May 8, 2015) will be completed prior to bringing CWF production down.
If, for any reason, satellite files are received late Saturday morning, they will be processed by CWF after the history archive has been completed.

The oldest claim history maintained after the purge process will be as follows:

• Oldest Inpatient Thru Date To Keep On File: 01/01/1966
• Oldest Outpatient Thru Date To Keep On File: 02/01/2013 (27 Months)
• Oldest Part B Thru Date To Keep On File: 05/01/2013 (24 Months)
• Oldest Hospice Thru Date To Keep On File: 01/01/1966
• Oldest Home Health Thru Date To Keep On File: 01/01/1998