CMS 2014 Medicare Physician Fee Schedule Final Rule and SGR Patch
Centers for Medicare and Medicaid Services (CMS) released the 2014 Medicare Physician Fee Schedule Final Rule on November 27. The Physician Fee Schedule Conversion Factor went from $34.0230 this year to $27.2006 for 2014. This is a 20.1% reduction from the current rate. The Anesthesia Conversion Factor was set to decrease about 25% from current.
Congress is expected to approve a three month SGR Patch to prevent the 20.1% cut. If this three month patch is approved, the 20.1% cut would be postponed until April 1, 2014. This ‘patch’ would set a .5% increase in the Physician Fee Schedule Conversion Factor for the months of January through March. Without further legislation, beyond the ‘patch’, the above 20.1% reduction will take effect April 1, 2014; however, it is hopeful Congress will continue to work on a permanent SGR repeal/replacement policy.
Affordable Care Act – Exchange Plans – How will the change in deductible amounts effect you?
The Exchange will offer many different plan levels for its members. Ranging from the Bronze to Platinum Plans and the majority of individual deductibles ranging from $1,000 to $6,350. With much higher deductibles than most have currently, this will definitely impact your revenues as this will be required to be collected from the patient/member. You will be required to rethink how you currently do business and become creative.
Thinking outside the box…
So, with the exchange upon us and the new plans set to go into effect January 1, 2014, will it be necessary to ‘think outside the box’ when it comes to pre-collecting patient responsibilities? Anesthesia Billing (ABI) most certainly thinks so; however, with anesthesia/hospital based providers, that is easier said than done. As the healthcare world continues to change around us, it will become even more important for you as a business owner to get with your facilities and work together in an effort to minimize the delay in payments as well as amounts that are sent to an external collection agencies for lack of member payments. ABI would highly recommend you start talking with your facilities to see what sort of solutions can be created.
Exchange Plan Rates and Limiting Provider Participation
In parts of the Country, some of the exchange plans are said to be limiting the provider network and pushing for lower reimbursements to the providers in comparison to the commercial plan rates. By lowering the reimbursements to the providers, the premiums to the members will be lower. Although the providers may not want to accept the lower reimbursements, because the networks will be smaller, the participating providers will, in essence, receive a higher volume of patients, possibly making the lower reimbursement more appealing. You will need to be on the alert as to what the payors in your area are doing with their exchange rates and network.
Marketplace/Exchange Individual Grace Period
The Affordable Care Act mandates a three month grace period for individuals who purchase a plan on the Exchange and who are delinquent in paying their portion of the premium. However, the grace period only applies to individuals who receive premium subsidies from the government and have paid at least one month’s premium within the benefit year. These claims should be pended by the payor and a letter received showing your claim(s) has been pended for non-payment of premium(s). If once the three month grace period is up and no payment on premium(s) has been made by the member, the claim(s) will be denied for no coverage. At that point, and only that point, can a statement be sent to the patient for payment of your claim. Providers may not bill the patient during that three month period. With this mandate, there will very possibly be a delay in a portion of your revenues; however, at this time, we cannot guess to what degree.
ICD-10 is Coming Soon – Will you be ready?
ICD-10, the new diagnosis coding system for medical claims, will go into effect October 1, 2014. That is less than eleven months away. The current ICD-9 system is being expanded from 17,000 to approximately 141,000 ICD-10 codes. Obviously, this broadening of code options will require MUCH greater detail in the provider’s notes as well as flexibility.
We live in a time and industry where ‘business as usual’ no longer applies. It will be more important than ever to DOCUMENT…DOCUMENT…DOCUMENT. There is not such things as too much detail. The level of detail necessary is greatly intensified with ICD-10.
Where anesthesia is concerned, many times the provider walks in the room just prior to the procedure and is quickly updated on the patient and diagnosis. This limited timeframe will probably not allow for ample information to be gathered to bill on the anesthesia claim.
It has been rumored the anesthesia claims will be denied if the diagnosis does not match the surgeon’s claim. With having over 8 times the possible options to choose from, you can imagine how improbable it will be the anesthesia claim will include the exact diagnosis codes as the surgeons claim with limited information.
With the increase in denials, comes delay of payments/revenues. It is highly suggested the anesthesia providers find a way to work with their surgeons on getting the diagnosis (ICD-10) they will be using. This will greatly cut down on possible denials on the back end and improve your accounts receivable.
It’s that time of year again to evaluate where your charges are!
It is once again a good time to look at your charge schedule and decide if you need to make any adjustment in what you are billing. If you determine you would like to make any kind of change, please contact Stephanie Kurtz via email at skurtz@anesthesiabilling.com, giving what change you would like to initiate and the effective date. If you have questions, please don’t hesitate to contact her at (316) 281-3710.
abinsights Contact Information
abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance. Send to: Anesthesia Billing, Inc., P O Box 388, Newton, KS 67114-0388. Phone 316-281-3700. Fax 316-282-4322.
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Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (pblann@anesthesiabilling.com).
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