After identifying errors in amounts for some items, CMS has released a revised fee schedule slated for Jan. 1 bid expansion.
CMS reported it had “identified errors in the fee schedule amounts for some items” in the fee schedule that it originally posted on Nov. 23. The newly revisedfee schedule released today is slated for implenetation on Jan. 1, 2016, to coincide with the nationwide expansion of competitive bidding prices.
Overall, the fee amounts are adjusted downward per CMS Final Rule 1614-F, and sections 1834(a)(1)(F) and 1842(s)(3)(B) of the Social Security Act. Those rules reflect the move to expand competitive bidding to non-bid areas, which goes into effect on Jan. 1, 2016. The rules require that CMS scrap the standard fee schedules and instead apply a new reimbursement scheme based on the single payment amounts in the competitive bidding areas.
Under the expansion plan, CMS will apply competitive bidding prices to claims for HME items currently covered Rounds One and Two of the program. An un-weighted average of all of the single payment amounts (SPAs) from the CBAs in each of the eight will be used to determine a regional single payment amount (RSPA) for each covered item.
From Jan. 1, 2016 to June 30, 2016, reimbursement for affected product categories will be based on 50 of the current, un-adjusted fee schedule, plus 50 percent of the RSPAs. Then, on July 1, 2016, the rates will drop to fully implement the bidding-derived rates.
CMS provided an announcement at http://bit.ly/1jN0JSO that provides a detailed explanation of the new fee schedule, as well as examples of how reimbursement would be cut for selected HCPCS codes in rural and urban areas. A compressed file containing all the documents pertaining to the fee schedule is available from CMS at http://go.cms.gov/1Y49Ig0.
The American Association for Homecare reports that it is reviewing the fee schedule, and will notify its members if CMS had made any major changes.