2018 Part B Fee Schedules and Medicare Updates

UPDATE: The fee schedules, accessible through the link below, have been updated for the SUSTAIN Care Act of 2018.

With the New Year upon us, HW&Co. would like to wish you a happy, healthy and prosperous New Year. As always, the New Year brings many changes to the Long-Term Care Industry. We are pleased to provide you with updates on some of these changes.

2018 Part B Fee Schedules

In conjunction with The Medicare Access and CHIP Reauthorization Act of 2015, which replaced the Sustainable Growth Rate (SGR) formula with new systems for establishing payment updates to the Medicare Part B physician fee schedules, the 2018 physician fee schedules will receive a .5% update, less a .09% adjustment for misvalued codes in prior years. However, in conjunction with the final rule for 2018, various adjustments to some of the underlying factors that are used to calculate the payments will be made effective January 1, 2018. As a result, the changes to the payments for each code will vary, in some cases widely, from the reported net .41% update.

The Therapy fee schedules provided below are effective from January 1, 2018 through December 31, 2018. It is important to forward the fee schedules to your business office personnel to use for January bills. Our Revenue Cycle Consultants are available to assist with any billing questions you may have. In addition, if you use PointClickCare, the Part B fee schedules are automatically updated in your system.

2018 Ohio Therapy Medicare Part B Fee Schedule

Many of the fee schedules change or are updated on a quarterly basis. Please review the appropriate schedule based on the Centers for Medicare & Medicaid Services (CMS) updates. Check the CMS website on a regular basis for updates to these schedules. Please note that these schedules are not all inclusive. We have attempted to limit this information to the most commonly used Healthcare Common Procedure Coding System (HCPCS) codes for long-term care facilities.

Fee schedules for lab, radiology, PEN and DMEPOS services are also available. These fee schedules may be helpful in negotiating contracts with your ancillary service providers.

Please contact your HW Healthcare Advisor if you would like a copy of one of these fee schedules for 2018 services.

Therapy Caps Exception Process Has Expired (though Congress May Reinstate)

The therapy caps exception process expired effective December 31, 2017, and Congress recessed without passing a temporary extension. Therefore, without other Congressional action, the caps for physical and speech therapy (combined) and occupational therapy will be $2,010 for 2018. Should you have a resident using significant Part B therapy in January, you may wish to hold off on billing those claims until more is known regarding Congress’ intentions.

In October, Congress appeared to have reached a bipartisan agreement permanently repealing the therapy caps, which would have also reinstated the manual medical review process with a $3,000 threshold (down from $3,700 previously). However, Congress did not finalize that agreement before its December recess. Congress reconvenes in January and has the ability to extend the exceptions process through 2018 or repeal the caps altogether. We will keep you informed of any action on the exceptions process.

Multiple Procedure Payment Reduction Remains in Effect

The Multiple Procedure Payment Reduction (MPPR) remains in effect for 2018. The MPPR cuts the practice component of the fee schedule payment for certain HCPCS codes by 50% when more than one kind of therapy is provided to a resident in a single day.

For 2018, the MPPR covers therapy services billed under 51 different HCPCS codes . The last column of the therapy fee schedules provided above shows the payment that would be made under the MPPR for the affected therapy codes.

January 1, 2018 Ohio SNF Medicaid Rates

Medicaid rates for most Ohio nursing facilities were recalculated on January 1, 2018 using the average of the June 30, 2017 and September 30, 2017 Medicaid case mix scores. The updated rates will impact payments from both traditional Medicaid and MyCare Ohio Medicaid. The statewide average rate as of January 1, 2018 is $195.21, an increase of $.80 over the July 1, 2017 average rate of $194.41. Rate setting reports are available in the MITS system.

It is important that you review these calculations closely as any errors must be corrected within 30 days of the receipt of your rate letter. Though ODM is putting additional pressure on the MyCare plans to accurately update the rates, be sure to review your MyCare payments carefully, as the MyCare plans have had significant issues in the past. Please contact us if you would like any assistance in reviewing your January 1, 2018 Medicaid rate or a detailed rate history analysis.

Make Sure Your PS&R System Login is Active!

Just a quick reminder that passwords for the CMS PS&R system expire every 60 days and must be changed. In addition, to avoid being locked out, the PS&R system must be accessed at least once every six months. We recommend you address any password or log in issues now to avoid delays in accessing your PS&R reports for the Medicare cost reports due in May.

Please contact your HW Healthcare Advisor with any questions on accessing the PS&R system.