The Balanced Budget Act of 2018 contains good news for anesthesia practices in 52 localities. The law raises the practice work geographic practice cost index (GPCI) to 1.000 in the 52 localities, which will in turn lift the locality-adjusted conversion factor for anesthesia services, and the increase will be retroactive to Jan. 1,
according to CMS 100-20, Change Request 10531.
The list of affected localities is at the end of this post. Check your Medicare administrative contractor (MAC) for your new conversion factor. For example, the anesthesia conversion factor for a participating anesthesia provider in locality
Rest of Pennsylvania rose slightly from $21.84 to $22.01.
Better still, MACs for these localities will automatically reprocess any claims that were submitted before mid-March.
Provided the claim can be automatically reprocessed, that is. From the business requirements section instructions for the change request:
Contractors shall automatically reprocess anesthesia claims for localities and states impacted by the work GPCI floor fee increase for dates of service in calendar year 2018. Please refer to the chart in Attachment A – Localities and States Impacted by the Work GPCI Floor – 2018.
That sounds good. However, the next instruction reminds practices to keep an eye on their claims.
Contractors shall reprocess anesthesia claims for localities and states impacted by the work GPCI floor fee increase for dates of service in calendar year 2018 which cannot be automatically reprocessed only if brought to your attention. Please refer to the chart in Attachment A – Localities and States Impacted by the Work GPCI Floor – 2018.
Essentially, if there’s something wrong with a claim, it won’t be automatically reprocessed. You’ll need to bring those claims to your MAC’s attention. And you’ll need to be patient. MACs have six months to reprocess claims.
This could add to the difficulties anesthesia practices already face because of the new codes for upper and lower GI endoscopy services. In particular, several readers have reported that claims for a combined upper GI endoscopy and colorectal cancer screening (00813-00833) are triggering denials faster than you can say “poor prep.”
One thing practices should not do – resubmit claims that have not been processed. That will trigger a denial and delay your payment. And when practices do receive their adjusted pay, they should check their MACs' math.
Localities that received a work GPCI increase to 1.000
- Alabama
- Arizona
- Arkansas
- Colorado
- Fort Lauderdale, Fla.
- Miami
- Rest of Florida
- Atlanta
- Rest of Georgia
- Idaho
- East St. Louis, IlI.
- Rest of Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- New Orleans
- Rest of Louisiana
- Southern Maine
- Rest of Maine
- Rest of Michigan
- Minnesota
- Mississippi
- Metropolitan Kansas City, Mo.
- Metropolitan St. Louis, Mo.
- Rest of Missouri
- Montana
- Nebraska
- New Hampshire
- New Mexico
- Rest of New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Rest of Oregon
- Rest of Pennsylvania
- Puerto Rico
- South Carolina
- South Dakota
- Tennessee
- Austin, Texas
- Beaumont, Texas
- Rest of Texas
- Utah
- Vermont
- Virginia
- Virgin Islands
- Rest of Washington
- West Virginia
- Wisconsin
- Wyoming