CMS instructs MACs to reprocess GPCI-lifted anesthesia claims

by Julia Kyles, CPC on Mar 21, 2018
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
  1. Alabama
  2. Arizona
  3. Arkansas
  4. Colorado
  5. Fort Lauderdale, Fla.
  6. Miami
  7. Rest of Florida
  8. Atlanta
  9. Rest of Georgia
  10. Idaho
  11. East St. Louis, IlI.
  12. Rest of Illinois
  13. Indiana
  14. Iowa
  15. Kansas
  16. Kentucky
  17. New Orleans
  18. Rest of Louisiana
  19. Southern Maine
  20. Rest of Maine
  21. Rest of Michigan
  22. Minnesota
  23. Mississippi
  24. Metropolitan Kansas City, Mo.
  25. Metropolitan St. Louis, Mo.
  26. Rest of Missouri
  27. Montana
  28. Nebraska
  29. New Hampshire
  30. New Mexico
  31. Rest of New York
  32. North Carolina
  33. North Dakota
  34. Ohio
  35. Oklahoma
  36. Rest of Oregon
  37. Rest of Pennsylvania
  38. Puerto Rico
  39. South Carolina
  40. South Dakota
  41. Tennessee
  42. Austin, Texas
  43. Beaumont, Texas
  44. Rest of Texas
  45. Utah
  46. Vermont
  47. Virginia
  48. Virgin Islands
  49. Rest of Washington
  50. West Virginia
  51. Wisconsin
  52. Wyoming
Blog Tags: claims processing, CMS, conversion factor
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