As Part B News reported, last month's the Bipartisan Budget Act fixed some problems with GPCIs in 52 localities and claims that exceeded the therapy cap nationwide that reduced payments for thousands of providers. Yesterday CMS officially acknowleged those changes.
Business left unfinished by Congress at the end of last year caused the 1.0 floor on work geographic practice cost indexes (work GPCIs) to expire in 52 localities, including the states of Wyoming, Oklahoma and Ohio and municipalities such as Atlanta and St. Louis. That meant providers in those states saw their work GPCI drop to as low as 0.961 -- meaning a reduction in Medicare payments.
The therapy cap exception process, by which providers could avoid the cap's $2,010 limit by adding a KX modifier to their claims, also expired at the end of 2017.
The budget bill, signed into law on February 9, fixed the GPCI floor and restored the therapy cap exceptions retroactive to the end of last year -- but there was some confusion as to whether payments made between January 1 and the fix would be fixed. CMS had previously said nothing about claims affected by the GPCI floor drop -- which, if they had been processed, would have been lower than the new law says they should be -- while therapy capped payments had been subjected to a "rolling hold."
In a February 28 announcement, CMS confirmed that "Medicare Administrative Contractors (MAC) will implement these changes no later than February 26, 2018, and will provide additional details on timelines for reprocessing or release of held claims impacted by these changes." Follow Part B News, where we'll notify you when they provide those details.
The announcement also confirms CMS' intention to implement other budget bill changes -- for example, the market basket for skilled nursing facility (SNF) payments is estimated to raise the projected rate in SNF payments from 1.8% to 2.4%.