2015 Part B Fee Schedules – Updated Effective July 1, 2015

As we previously reported, Congress finally passed a permanent “doc fix” in April 2015.  The Medicare Access and CHIP Reauthorization Act of 2015 replaced the Sustainable Growth Rate (SGR) formula with new systems for establishing payment updates to the Medicare Part B physician fee schedules.  Without the legislation, Part B rates would have decreased by approximately 21% on April 1, 2015.

The bill included a continuance of the “zero percent” update through June 30, 2015 and a .5% update effective for services provided from July 1, 2015 through December 31, 2015.  As a result, we have calculated the new fee schedules to be effective on July 1, 2015.

It is important to forward the fee schedules to your business office personnel to use for July bills. The schedules are available in PDF format in the links below.  Our Revenue Cycle Consultants are available to assist with any billing questions you may have. In addition, if you use PointClickCare, we can electronically upload the fee schedules for you.

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.

Updated Ohio Medicare Part B Fee Schedules

1. Medicare Part B Therapy
2. Radiology

Therapy Caps Exception Process Extended

The bill passed by Congress also included an extension of the therapy caps exception process through December 31, 2017. The caps for physical and speech therapy (combined) and occupational therapy will remain at $1,940 for 2015.  The manual review processes for beneficiaries that reach $3,700 of therapy services was also extended through December 31, 2017.

ICD-10 Implementation is Less Than 100 Days Away!

We are less than 100 days from the implementation on ICD-10!  ICD-10 was developed in 1993, but its implementation has been repeatedly delayed in the United States.  However, the Department of Health and Human Services (HHS) has said it has no plan to delay the implementation any further than the currently planned October 1, 2015 implementation.  In addition, CMS has stated there will be no grace period for claims submitted using ICD-9 coding.  Your staff responsible for coding and billing must be prepared as soon as possible for the change to ICD-10.  In addition, you must make sure your software systems are prepared for the transition to ICD-10.  Any failure to properly train and prepare for ICD-10 could have major impacts on your billing and cash flows.

Governor Signs Fiscal Year 2016-2017 Budget

Governor Kasich signed Amended Substitute House Bill 64 into law on June 30, 2015.  The bill, which includes Ohio’s biennium budget for fiscal years 2016 and 2017, includes various provisions impacting skilled nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID).  SNF provisions include rebasing of prices and a new quality incentive calculation, both effective July 1, 2016.  The Governor line-item vetoed a provision that would have required the Ohio Department of Medicaid (ODM) to use the RUG-IV 48 grouper in its rebasing calculation.  ODM will now have the ability to choose whatever grouper it determines is appropriate.

The ICF/IID provisions of the bill were essentially based on an agreement between the Department of Development Disabilities (DODD) and the provider associations.  There were no significant changes to the reimbursement formula for the July 1, 2015 rate calculations.  The bill does include various policy matters regarding downsizing and conversion, including provisions to reduce the number of residents in rooms with three or more people.

We will provide you with more detail as we analyze the budget bill and its potential impact on Ohio providers.  Please see the article below for more detail on Medicaid rates as of July 1, 2015.

July 1, 2015 Ohio Medicaid Rates

Medicaid rates, effective July 1, 2015 for skilled nursing facilities in Ohio, have been finalized by the Ohio Department of Medicaid.  Rate calculations were mailed by ODM to skilled nursing facilities early this week.  The rates were established using the average of the December 31, 2014 and March 31, 2015 Medicaid case mix scores (excluding PA1 and PA2 assessments), as well as the updated quality incentive for fiscal year 2016.  All but four skilled nursing facilities earned the maximum $16.44 quality incentive.  As a reminder, fiscal year 2016 will likely be the final year for the current quality incentive as it will be replaced by a new quality formula effective July 1, 2016.

MyCare Ohio plans are required to pay nursing facilities at least the same Medicaid rate they received from the traditional Medicaid program.  The plans have received the new rates from ODM and are in the process of loading them into their systems.  Therefore, it is very important you review your upcoming payments from the MyCare Ohio plans to ensure you are being paid at the correct rates for both June and July services.

Medicaid rates for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) are still being calculated by the Department of Developmental Disabilities (DODD).  DODD must calculate the direct care ceilings to ensure that: (1) there is no overall rollback to rates, and (2) the same percentage of large and small facilities are covered by the direct care ceilings.  DODD plans to send the rate setting packages to providers by the end of July to ensure that payments for July services are paid at the correct rates.

Any requests for rate reconsiderations must be made within 30 days of the date of the rate setting.  Therefore, time is limited to correct any errors in your rate calculations.  If you would like us to review your Medicaid rate calculations, please forward your rate setting packages to an HW Healthcare Advisor.