Are Medicare fees going up? Or down?

July 24th, 2014

PAMA (up 0.5%)

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014 (PAMA). Within this law, Congress instituted changes that went into effect on July 1, 2014. The law provided for a 0.5% update for claims with dates of service on or after January 1, 2014 through December 31, 2014. PAMA also provided a zero percent update to the 2015 Medicare Fee Schedule through March 31, 2015.

Sequestration (down 2%)

Previous budgetary restrictions led to a 2% sequestration reduction in fees. Sequestration is to remain in effect through at least March 31, 2015. This means that you will continue to see a 2% reduction in reimbursement from Medicare. If you are a participating physician in the Medicare part B program, you will continue to charge the Medicare amount and collect co-pay amounts; however you will see a 2% reduction in the amount Medicare reimburses to you. The provider is not allowed to collect the 2% from the patient. For a non-participating physician, since the patient pays the provider up front, the patient will see a 2% reduction in the reimbursement amount from Medicare.

Chiropractic Demonstration Project (up 2%)

In addition, the Medicare fee schedule will also see another increase in chiropractic manipulation reimbursement. The Medicare demonstration project, while scoring high for chiropractic in customer satisfaction, resulted in payments that were $50 million over budget. To recoup that amount, Medicare has been reducing reimbursement for 98940, 98941 and 98942 by 2%. CMS has announced that the recouped amounts have now replaced the monetary downfall and the 2% recoupment due to the demonstration project has now ended. This will result in a 2% increase in reimbursement for chiropractic services 98940, 98941 and 98942 in the Medicare program. The fee schedule is expected to be updated on July 1, 2014. Physicians should check with their local carrier on-line for the new amounts for their locality.

Electronic Health Record/Meaningful Use (down 1% for some)

Eligible professionals have until July 1, 2014 to start using their EHR in accordance with meaningful use guidelines. If you have not begun to use electronic health records by July 1, 2014, then fines will be levied beginning in 2015. Meaningful use is for all of your patients; incentive money is based on the services you performed on active care Medicare part B patients. Meaningful users will be subject to a payment “adjustment” beginning on January 1, 2015. The reduction will increase 1% per year.

Though it is most likely too late, eligible professionals may be able to apply for hardship exceptions to avoid the payment adjustments described above. Hardship exceptions will be granted only under specific circumstances and only if CMS determines that providers have demonstrated that those circumstances pose a significant barrier to their achieving meaningful use. 

Physician Quality Reporting System - PQRS (down 1.5% for some)

For all providers in the Medicare Part B program, PQRS is mandatory for 2014. 50% of all eligible patients under the Medicare Part B must have the appropriate quality measures reported for 2014. If the provider does not report the meaningful use measures on at least 50% of active care patients in the Medicare part B program, then a payment adjustment (penalty) of 1.5% will be assessed in 2016. 2015 will see penalties assessed due to improper reporting, in 2013.

Chiropractors must only report on three measures:

However, blood pressure must be reported at least once for each patient in the reporting period. The reporting period is listed as once per year, however, if the patient has not been seen recently, then they must have the blood pressure reported at least once between July 1, 2014 and December 31, 2014. Additional readings may be required to meet PQRS regulations.

The PQRS measures and EHR Meaningful Use are among the measures that will be applied to all providers in 2016.

Value-Based Modifier (down 1% or up 2%)

Most chiropractors will see their reimbursement affected by the Value-Based Modifier beginning in 2017. The Value Modifier provides for differential payment to a physician under the Medicare Physician Fee Schedule based upon the quality of care furnished compared to cost during a performance period. It is based on participation in PQRS. Information on this program is still forthcoming.

As you can see, not keeping up with requirements will result in as much as a 5% reduction in your reimbursement. Many insurance companies have indicated that they will follow the reductions imposed under the Medicare program for each provider.


This article was written mostly by Mario Fucinari DC, CCSP. MCS-P, with some contributions from Evan M. Gwilliam DC MBA CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA

Dr. Fucinari will be presenting a several classes and webinars to aid the doctor and staff in correct compliance procedures. For an updated schedule of classes and locations, go to Dr. Fucinari is a Certified Medical Compliance Specialist and a Certified Insurance Consultant. For further information on compliance audits, manuals or record reviews, please contact Dr. Fucinari at

Dr. Gwilliam is the Vice President of ChiroCode. He can be reached at


Are Medicare fees going up? Or down?. (2014, July 24). Find-A-Code Articles. Retrieved from

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)

Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (8-5 Mountain)
free demo
request yours today
free subscription
for any budget

Thank you for choosing Find-A-Code, please Sign In to remove ads.