MPFS Cut Gone, Not Forgotten

With the enactment of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 on July 15 comes several important changes. Of course, the headline news is that the 10.6 percent rate reduction to the Medicare Physician Fee Schedule (MPFS) that went into effect on July 1 is waylaid for the next 18 months. MPFS rates are now back to what they were in the first half of the year. According to the Centers of Medicare & Medicaid Services (CMS), Medicare contractors will continue to process the claims put on a 10-day hold on a first-come, first-serve basis at the reduced rate. Contractors will then automatically reprocess any claims submitted between July 1 and July 15 that were paid at the lower rates “to the extent possible.” MIPPA also ensures physicians receive a 1.1 percent increase in MPFS rates in 2009.

Here’s the rest of the story
MIPPA postpones the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. According to Highmark Medicare Services, the July 21 accredited or applied accreditation deadline and the Jan. 14, 2009 obtaining accreditation deadline no longer apply. The Sept. 20, 2009 deadline for all DMEPOS suppliers to be accredited is still in effect. What this means is that the items included in the first round of the DMEPOS Competitive Bidding Program can now be furnished by any enrolled DMEPOS supplier in accordance with existing Medicare rules. Payment for these items will be made under the fee schedule.

The therapy caps exceptions process was also reinstated as of July 1. MIPPA extends the use of the cost to charge payment methodology for brachytherapy and therapeutic radiopharmaceuticals through Jan. 1, 2010. Outpatient therapy service providers may continue to submit claims with the KX modifier Requirements specified in the medical policy have been met for therapy services that exceed the cap. For 2008, the incurred expenses limit is $1,810 for both physical therapy and speech language pathology services combined and occupational therapy services. Once again, contractors are expected to mass adjust all claims processed using the Outpatient Prospective Payment System (OPPS) rates in effect between July 1 and July 15 “in a timely manner,” CMS reports. Further information is available on the CMS Web site.

MIPPA also continues to allow independent laboratories technical component (TC) Medicare billing of physician pathology services furnished to covered hospital patients, regardless of a beneficiary’s inpatient/outpatient status. MIPPA establishes a new moratorium extension effective for claims with dates of service between July 1 and Dec. 31, 2009. Be sure to read CMS Transmittal 1561, CR6042, dated July 25, for the latest requirements.

Ambulance fee schedule amounts for ground ambulance services will increase. The increase will be effective for claims with dates of service on or after July 1, 2008, and before Jan. 1, 2010. For covered ground ambulance transports originating in rural areas, the fee schedule amounts increase by 3 percent; and for covered ground ambulance transports originating in non-rural areas, the fee schedule amounts increase by 2 percent.

A complete summary of provisions in H.R. 6331 is available online; and MLN Matters article SE0826 is available on the CMS Web site.

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