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CMS clarifies actions on expiring provisions

April 1, 2015
by Lois A. Bowers, Senior Editor
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As the U.S. Senate continues its spring recess, the Centers for Medicare & Medicaid Services (CMS) in a special communique to providers today clarified what actions it will take until sentators return to the nation’s capital in mid-April to vote on the “doc fix” bill passed March 26 by the House of Representative. Several provisions that may be addressed by passage of the bill expired today.

  • Therapy caps. Based on current law, CMS will consider exceptions to the per-beneficiary cap amounts for occupational therapy, and for physical therapy and speech-language pathology services combined, which are allowed for services above the caps that are deemed reasonable and necessary, only for dates of service through March 31.
  • Physician payment. The negative 21 percent payment rate adjustment under current law for the Medicare Physician Fee Schedule was scheduled to take effect April 1. To minimize the need for claims reprocessing and the disruption of physician cash flow, CMS will hold claims “for a short period of time” beginning today and will implement any subsequent congressional action addressing the 21 percent payment reduction. Under current law, electronic claims are not paid sooner than 14 calendar days, or 29 days for paper claims, after the date of receipt. CMS said it will provide more information about its next steps by April 11.
  • Ambulance services. Medicare provided for an increase in the ambulance fee schedule amounts (both base rate and mileage) for covered ground ambulance transports that originated in rural areas by three percent and covered ground ambulance transports that originated in urban areas by two percent. Also, Medicare provided for an increase of 22.6 percent in the base rate of the ambulance fee schedule amount for covered ground ambulance transports that originated in rural areas designated as “super rural.” These provisions expired April 1.
  • Low-volume and Medicare-dependent hospitals. The Affordable Care Act and subsequent legislation made temporary changes to the low-volume hospital payment adjustment for hospitals that met certain discharge and mileage criteria. The Medicare-dependent hospital program also provided enhanced payment to support small rural hospitals where Medicare patients make up a significant percentage of inpatient days or discharges. These temporary changes expired April 1.
  • Recovery audits. CMS will continue to prohibit recovery auditor inpatient hospital patient status reviews for dates of admission between Oct. 1, 2013, and April 30. CMS also will continue the Inpatient Probe and Educate process through April 30.

“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,” CMS said. “We are working to limit any impact to Medicare providers and beneficiaries as much as possible.”

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