CMS Delays 2014 Final Rule

CMS_delayFinancial woes and indecision by the government may seem far away when it comes to medical billing management; but when it comes to getting paid, your staff needs to stay current on what's happening in D.C.  

The government shutdown didn't give the regulators over at the Centers for Medicare & Medicaid Services much time off, so be prepared for their final rule making on November 27, 2013 with an effective date of New Year's day 2015.

Although most of the proposed changes in Washington will more considerably affect your patients, there's one that has been brewing since the Deficit Reduction Act (DRA) in 2005, which capped the technical component (TC) reimbursement for imaging providers at either the Medicare Physician Fee Schedule (MPFS) or the Hospital Outpatient Prospective Payment System (HOPPS).  Whether you're part of an orthopedic practice that deals with MPFS rates or a radiology provider affiliated with a hospital in a satellite location (HOPPS billing), both fee schedules will be reduced, some by as much as 38 percent.

The American College of Radiology compiled a listing of 70000 CPT codes and those non-70000 codes commonly used by radiologists, with a side-by-side of rates for 2013 and those proposed for 2015, with a percentage rate of change.  With reduced rates of reimbursement, medical billing management needs to stay up on current procedure codes to ensure timely and accurate EDI submissions.  The devil is in the details, though, and this is nowhere more evident than the morass of rule changes, with such hidden pitfalls as the fact that you may be using the right CPT code for a pre-service procedure, such as 37202 for a transcatheter therapy infusion, the general time allowed to do this has gone from 45 minutes to zero, which basically begs the question, is this suddenly non-billable?      

Another significant change is in durable medical equipment; so if your practice of facility was about to make an investment in DME, your medical billing management will need to know the new direct input for equipment to match reimbursable CPT codes.  For example, the Centers for Medicare & Medicaid (CMS) are proposing the descriptor of "bronchofibervideoscope," which more closely matches CPT code 31620, i.e., endobronchial ultrasound.  Unfortunately, there are yet no pricing inputs in the PR database, so practices are encouraged to submit copies of their paid invoices to establish pricing guidelines.

Stay tuned for news of the proposed changes that should hit right after Thanksgiving and prepare to ring in the new year with new guidelines.  If you want to avoid the headaches, consider utilizing a team of professionals who can navigate these changes, such as the services offered by HIS.

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