CMS Publishes Information on Claims Reprocessing per the Bipartisan Budget Act of 2018
Wed, Mar. 28, 2018

The Bipartisan Budget Act of 2018 that avoided a government shut down in February also included some provisions that will impact Medicare payments under the Physician Fee Schedule (PFS). The Bipartisan Budget Act extended the 1.000 floor to the Geographic Price Cost Index (GPCI) for work. This is a nuanced but important point that impacts previous and future Medicare payments in certain locales.

As a refresher, the Medicare PFS includes payment for work, practice expense (PE) and professional liability insurance (PLI). Relative value units (RVUs) are assigned to each of these three components at the code level for services paid via the Resource Based Relative Value System (RBRVS). To account for locale-specific cost variations, those RVUs are adjusted up or down based on the GPCIs assigned to the geographic locale. The adjusted RVUs for work, PE and PLI are added together and the resulting sum is multiplied by a conversion factor. Because anesthesia base units are not divided into work, PE or PLI components, the anesthesia conversion factor is adjusted per locale.

The Centers for Medicare & Medicaid Services (CMS) has issued Transmittal 2047 (PDF) outlining how Medicare Administrative Contractors will automatically reprocess impacted claims retroactive to January 1, 2018. CMS has also issued updates to the anesthesia conversion factor for locales where the work GPCI had dipped below 1.000. If you provide services in one of the affected locales listed in the CMS Transmittal, review this information to confirm that you receive the correct payment for services provided.

Click here for updated anesthesia conversion factors.

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