Medicare

2015 Medicare Fees

On January 21, 2015, the Centers for Medicare and Medicaid Services (CMS) announced that it was making emergency changes to the 2015 physician fee schedule because of calculation errors made by CMS. Because of these CMS errors, fees downloaded from the NYSPA website are incorrect. The fee schedules are currently being updated and the revised fee schedules will be posted here as soon as they are complete. Click here to access the CMS newsletter, MLN Matters, announcing emergency changes.

In addition, the original fee schedules published by the Medicare carrier, National Government Services (NGS) failed to properly calculate the EHR penalty.

Providers who did not meet the EHR meaningful use requirements in 2013 but were successful electronic prescribers or applied for and received an electronic prescribing waiver in 2013 are subject to only a 1% EHR cut in their 2015 fees.

However, providers who have not met meaningful use requirements in 2013 and were also not successful electronic prescribers or did not secure an eRx waiver in 2013 are subject to a 2% EHR cut in their 2015 fees. Thus, the EHR cut is either 1% or 2%. Our corrected NYSPA fee schedules will incorporate the newly corrected fees from CMS and the correct calculation of the EHR reduction. We will send out an E-Bulletin notifying members when the revised fees have been uploaded to the NYSPA website.

 

2015 Medicare/PQRS Update Webinar

Presenter: Seth P. Stein, Esq. & Rachel A. Fernbach, Esq.
Webinar Date: December 15, 2014

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2015 Medicare/PQRS Update Webinar
Powerpoint Slides

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2014 Medicare Fee Schedules

Below is a chart that highlights the dramatic impact the new combo codes have had on the Medicare fees. The steady rise in fees in 2013 and 2014 results directly from the change to the combination codes for psychotherapy and reinforces NYSPA advocacy for the coding changes.  Our next challenge is to work with the commercial carriers to have follow Medicare’s lead  on pricing psychotherapy services.

Medicare Fee Comparison

The 2014 Medicare fee schedules can be accessed by clicking the "read more" link below.

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Providers Who Wish to Continue to Submit CMS-1500 Paper Claim Forms to Medicare May Need to Act Now to Avoid Discontinuation of Their Administrative Simplification Compliance Act (ASCA) Exception Status

National Government Services (NGS) Medicare recently released the following information regarding paper claim submission:

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