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Navigate Medicare Payment Rates in the New Year

Wednesday, December 19, 2018 9:00 AM

BSM Products and Services, Billing, Coding & Compliance

Written by: Patricia Kennedy

Patricia Kennedy
Former Senior Consultant

As 2018 draws to a close, practices and ambulatory surgery centers (ASCs) are busy setting their goals for the upcoming year. With so much to pay attention to in 2019, it’s important to not lose sight of important updates that could affect your organization. At BSM, we’ve been focused on developing more innovative ways to help our clients, specifically with staying up to date on billing and coding changes moving into the new year.

New Year, New Fees

Recently, the Centers for Medicare and Medicaid Services (CMS) published its final 2019 updates to the Medicare Physician Fee Schedule (PFS). With Jan. 1 right around the corner, it can be overwhelming for billing staff to distill this raw data and incorporate new payment policies, rates, and codes before the beginning of the year.

This annual PFS report includes a lengthy list of Current Procedural Terminology (CPT) codes for all disciplines in the medical field. This includes individual components and indicators that make up the value of each code, which ultimately determine the payment rate for a particular service. Billing staff must use this data to search for relevant codes based on practice location and then determine the Medicare allowable for each code. While this exercise is tedious, it is necessary to build 2019 fee schedules that effectively encompass commercial contractor reimbursement.

New Medicare Payment Rates Tool

To provide your billing staff with an easy-to-use solution that eliminates the guesswork, our Rose & Associates team — a division of BSM — created an eye care-specific Excel tool that is customized based on your practice’s geographic location. This new Medicare Payment Rates (MPR) tool provides:

  • Professional allowables for visits (including diagnostic tests and minor and major surgeries),
  • “Ophthalmology-only” allowables for the coming year,
  • Global fee periods, and
  • Multiple services indicators.

All this important data is outlined in a straightforward format, omitting extraneous information provided in the PFS report.

Furthermore, the MPR tool is easily searchable. This means when your billing staff encounter a “random” eye care code in your billing batch, the code and Medicare allowable can be quickly referenced. If a practice finds it needs a more extensive set of codes, our Rose & Associates team can provide that, as well.

The MPR tool is compatible with most electronic practice management (EPM) systems, allowing you to seamlessly integrate your reimbursement rate data directly into your EPM. We also provide a PDF version for your desktop.

This eye care-specific MPR tool is uniquely equipped with the following features:

  • Pre-applied Geographical Practice Cost Indices (GPCIs), ensuring allowable amounts match what your Medicare Administrative Contractor will show;
  • Notification of any CMS updates throughout the year; and
  • An easy-to-use payment indicator legend.

Coming Soon

In the near future, an ASC-specific MPR tool will be available. At the time of this publication, CMS has not yet published all the 2019 ASC values. However, we anticipate they will be available soon. Once these values are available, Rose & Associates is ready to create the GPCI-adjusted ASC allowables tool for your facility.

The ASC-specific MPR tool will be uniquely equipped with the following features:

  • Allowables for surgical procedures performed in an ASC adjusted by wage indices;
  • Allowables that are either eye care-specific or applicable to all procedures; and
  • Regular updates throughout the year, if needed, with customers receiving a notice that includes a link to download the latest version.

By leveraging these MPR tools, you will save your billing staff endless hours of adjusting your fee rates while more effectively optimizing reimbursement, helping to ensure your organization has a prosperous 2019!

LEARN MORE: Visit BSM’s Medicare Payment Rates page to learn more about the features, benefits, and pricing of the Medicare Payment Rates tools. Direct questions to or call 1-800-832-0609. 

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