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Medicare Physician Fee Schedule Database changes

When CMS has an issue, we all have an issue. The latest problem concerns the Medicare Physician Fee Schedule database (MPFSDB). The fee schedule was released in November in the Federal Register but now has been cancelled by CMS for correction of unspecified errors. National Government Service and NHIC, MACs, have announced they are holding claims until January 15, 2015. Palmetto, another MAC, has announced that the delay could be until January 20, 2015.

As health plans or delegated entities, many issues face your claims department. There are new AMA and HCPC codes that you will not have pricing for and, in addition, there were many changes in the RVUs by the AMA RUC committee. Network contracts may call for shorter turn-around times than fee for service Medicare and obligate payment.

PCG has abandoned weeks of work based on the November MPFSDB and will be issuing the 1st Quarter Virtual Examiner® update without the 2015 fee schedule but with the CCI edits and other changes. When the final fee schedule is released by CMS, we will issue another Virtual Examiner version.

The following information has been included so that you have reference documents and can present information to your provider networks and staff.

National Government Service

On November 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015, (i.e., Thursday, January 1 through Wednesday, January 14). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

Palmetto GBA

CMS is in the process of issuing a revised 2015 Medicare Physician Fee Schedule. The revised fees will be published on or before January 20th.

Our Palmetto GBA Medicare Physician Fee Schedule (MPFS) tool allows you to display or download fees, indicators, and indicator descriptors. Start by selecting your fee’s year in the box below. As you answer questions, new ones will appear to guide your search. Use the “Clear” button to change the year or contractor. For more assistance with this tool, visit our Help page or fill out the Feedback form. For other fees not included in this tool (Ambulance, ASC, DMEPOS, Drugs and Clinical Laboratory) please visit our Fee Schedule Web page. You can find additional information on the CMS Physician Fee Schedule page.

Andria Jacobs, RN, MS, CEN, CPHQ, COO
PCG Software, Inc.
877-789-1291 x 203