Physician Fee Schedule Proposed Rule 2018

On Thursday, July 12, the Centers for Medicare & Medicaid Services (CMS) released the “Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program” Proposed Rule (Proposed Rule). As you know, the American Ambulance Association worked closely with the Congress to ensure passage of the Bipartisan Budget Act of 2018 (BBA) (Pub. L. 115-123, enacted on February 9, 2018). The BBA not only extended the ambulance add-ons for 5 years, but also authorized a cost collection system that would not be overly burdensome on ambulance providers and suppliers, but would provide sufficient information ideally to support the permanent extension of the add-ons and set the basis for new payment models, including alternative destinations, treatment/assessment without transport, and community paramedicine. After passage of the BBA, the AAA engaged immediate with CMS to ensure the smooth implementation of these provisions. Those contacts resulted in guidance earlier this year implementing the add-ons retroactively to January 1, 2019. Consistent with the statute and already-released guidance, the Proposed Rule extends the three add-ons: the 2 percent urban, 3 percent rural, and 22.6 percent super-rural...

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Preliminary Estimate of 2018 Medicare Rates

A Preliminary Estimate of 2018 Medicare Rates In this blog, I will provide a preliminary estimate of the Ambulance Inflation Factor (AIF) for calendar year 2018.  The AIF is main factor that determines the increase (or decrease) in Medicare’s payment for ambulance services. Calculating the 2018 AIF The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year. For 2018, this means the 12-month period ending on June 30, 2017. Starting in calendar year 2011, the change in the CPI-U is reduced by a so-called “productivity adjustment”, which is equal to the 10-year moving average of changes in the economy-wide private nonfarm business multi-factor productivity index (MFP). The resulting AIF is then applied to the conversion factor used to calculate Medicare payments under the Ambulance Fee Schedule. The formula used to calculate the change in the CPI-U is limited to positive increases. Therefore, even if the change in the CPI-U was negative over a 12-month period (a rarity in the post-war era), the change in the CPI-U cannot be negative. However, when the MFP reduction is applied, the statute does permit a...

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CMS Issues Proposed Rule for CY2016

Recently, the Centers for Medicare and Medicaid Services (CMS) published a display copy of a proposed rule that makes a number of changes to the Medicare Physician Fee Schedule.  It also makes certain changes to the Medicare Ambulance Fee Schedule. AAA members, read more in this summary by Medicare consultant Brian Werfel. Not yet an AAA member? Learn more about how AAA membership can help you stay up-to-date on critical regulatory and reimbursement issues that impact your ambulance service.

CMS Issues Proposed Rule for Calendar Year 2016

On July 8, 2015, the Centers for Medicare and Medicaid Services (CMS) published a display copy of a proposed rule titled “Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016”.  The proposed rule makes a number of changes to the Medicare Physician Fee Schedule.  It also makes certain changes to the Medicare Ambulance Fee Schedule.  These proposed changes are summarized below. CMS is soliciting comments on numerous aspects of the proposed rule.  All comment letters should reference File Code: CMS-1631-P.  To be considered, comments must be submitted on or before the close of business on September 8, 2015. Read the full proposed rule. The proposed rule will appear in the Federal Register on July 15, 2015. Technical Corrections to Reflect Extension of Temporary Adjustments for Ground Ambulance Services Section 203 of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L 114-10) provided for an extension of the temporary adjustments for ground ambulance services through December 31, 2017.  CMS is proposing to amend the regulations at 42 C.F.R. §414.610 to reflect this extension. Specifically, CMS is proposing the following changes: Urban/Rural The regulation, 42 C.F.R. 414.610(c)(1)(ii) would be amended...

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