Part B Insider (Multispecialty) Coding Alert

Published on Mon Apr 14, 2014 PDF

New legislation is more than just an ICD-10 extension.

Although the ICD-10 delay has gotten most of the attention in the Protecting Access to Medicare Act of 2014 that President Obama signed on April 1, that’s not the only feature of the bill. Check out these three additional topics you need to know about the physician pay fix.  

1. Not just a pay fix: Although the bill has universally been referred to as a “pay fix” legislation, the reality is that it provides a “patch” to the 24 percent pay cut that was supposed to go into effect on April 1, but does not propose a permanent fix—which was what most doctors had actually hoped for. Instead, the new law provides a 0.5 percent update for claims with dates of service on or after Jan. 1, 2014, through the end of 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015. “CMS is currently revising the 2014 MPFS to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November,” CMS said in an April 2 statement. The updated 2014 conversion factor is $35.8228. 

2. Therapy cap exceptions process extended: Therapy providers had been biting their nails over the fact that the therapy cap exception process was due to expire on March 31, but the new law extends the program for another year. “Providers of outpatient therapy services are required to submit the KX modifier on their therapy claims when an exception to the cap is requested for medically necessary services furnished through March 31, 2015,” CMS says in its news release.  

3. Extension of work GPCI floor. The existing 1.0 floor on the physician work geographic practice cost index (GPCI) has been extended through March 31, 2015. You’ll find the details of the GPCI updates in the revised 2014 Fee Schedule.