Find-A-Code Focus Newsletter

Medicare Fees Discrepancies

January 08, 2013

We have been receiving quite a few calls and chats from concerned providers about Medicare fee amounts. When they go to their local Medicare carrier website and download fee schedules, the numbers are quite lower than what they are seeing in FindACode.com.

The problem appears to stem from two different situations:

  1. Averted Fee Cut:
    Please be aware that most local Medicare carrier files were created back in 2012 when the 26.5% pay cut was scheduled to take effect on January 1, 2013. Congressional action stopping this cut did not happen until the very last minute. On January 2, 2013, the American Taxpayer Relief Act of 2012 (ATRA), was signed into law.

    In the CMS announcement regarding the effects of this law (www.findacode.com/news), the conversion factor is set as $34.0230 which is just slightly different than last year's conversion factor ($34.0376), but very close. Not all codes had RVU changes so some of your fees may be the same, but some RVUs did change so some fees may be slightly different than the last quarter of 2012.

    How do you know if you are looking at the right data? If you download carrier information, you must look at the file creation information, not a file title or description of the file. Any file created prior to January 3, 2013 will show what the fees were supposed to be on January 1. The law just barely changed what the fees should be for 2013.

    Additionally, it also appears that some carrier fee calculation tools are also using the old fee cut data. Please use caution when evaluating data on local Medicare carrier websites.

    CMS has stated the following, "In order to allow sufficient time to develop, test, and implement the revised MPFS, Medicare claims administration contractors may hold MPFS claims with January 2013 dates of service for up to 10 business days (i.e., through January 15, 2013)." Based on this statement, it is likely that any fee schedule files or fee calculators on the local Medicare carrier websites may not be corrected until January 15, 2013.

  2. Carrier Changes: (only applies to some states) 
    During the Summer/Fall 2012, the Medicare part A/B providers for Arkansas, Louisiana, Mississippi, Colorado, New Mexico, Oklahoma, and Texas transitioned to Novitas Solutions, Inc. CLICK HERE to read about that change.

    If we had automatically updated your account to use the new carrier, you would not be able to easily review the old carrier fees and LCDs. Instead, we kept the client/fee schedule information the same. To see the new information, simply go into your account and create a new client/fee schedule. This allows you to switch back and forth between carriers by simply changing the "Client Codes/Fee Schedule" drop down box at the top right corner (underneath your name and "Viewing" date). Be sure to give it a descriptive name (like adding the date of the change or the name of the carrier) so you can easily distinguish between the two fee schedules.

Rest assured that the fees you are seeing in FindACode.com really are the fees as of January 1, 2013.


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