2010-05-25

On May 10, Medicare contractors received new files that address corrections in the final 2010 physician fee schedule rule, as well as implementation of several provisions in the Patient Protection and Affordable Health Care Act (PPACA) enacted earlier this year. All the changes are retroactive to January 1, and all contractors must implement them by May 31.

The PPACA provisions implemented in the new file would do the following: extend the 1.0 work geographic practice cost index (GPCI) floor that expired on Dec. 31, 2009, and raise practice expense GPCIs in low-cost areas by reflecting only half the geographic wage and rent cost differences in their calculation; extend the current 5 percent add-on payment for specified psychiatry services; increase payments for bone density tests; extend the therapy cap exception that expired on April 1; and extend a provision allowing independent labs to bill for the technical component of physician pathology services. The corrections to the final 2010 rule involve cardiology.

Once the contractors have the new files in place, all claims going forward will be processed at the revised rates. However, the Centers for Medicare and Medicaid Services is still discussing the best way to handle the 2010 claims that were paid at the rates in effect before these corrections and updates were made. Until a process is in place for handling the amended claims, physicians should not resubmit previously-processed claims affected by the payment changes, since these resubmissions will likely be denied as duplicate claims.

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