The Bipartisan Budget Act of 2018 is requiring Medicare administrative contractors (MACs) to reprocess practice claims, which could mean some physicians will see a boost in reimbursement.
Under the Medicare physician fee schedule (MPFS), your total relative value units (RVUs) are composed of RVUs for physician work, practice expenses, and malpractice insurance. Medicare multiplies the physician work component by a geographic practice cost index (GPCI) based on where you are practicing. Before 2018, the law established 1.00 as the minimum level for the GPCI, but that expired at the end of last year, allowing the minimum to dip in some places.
Section 50201 of the Bipartisan Budget Act of 2018 restored the GPCI minimum of 1.00 retroactive to Jan. 1, which will increase Medicare payments for many physician services in many localities around the country. (See Attachment A of this notice for a chart of cities and states affected.)
The Centers for Medicare & Medicaid Services (CMS) has instructed MACs to reprocess fee schedule claims for dates of service in 2018 in areas where the GPCI has increased because of the change. MACs are to begin reprocessing claims on April 2. If the MAC in your area does not automatically reprocess your affected claims, you may need to alert your MAC.
For more information, see the Medicare Learning Network Matters article published by CMS.
– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians
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