Recently, AHCA reached out to the Centers for Medicare and Medicaid Services (CMS) regarding providers receiving incorrect payments for March 2024 Medicare Part B services, including physical and occupational therapy and speech-language pathology services for services furnished on or after March 9 through March 31, 2024.
As a result of this outreach and request for correction, CMS this week posted guidance for providers impacted by this or similar issues in the MLN Matters weekly update. It recommends that providers submit split outpatient claims for March 2024 so that the updated Part B physician fee schedule rates can be paid properly beginning with the new rates effective March 9.
Background
The Consolidated Appropriations Act of 2024 updated the Medicare physician fee schedule rates for Part B services to be effective with dates of service beginning on March 9, 2024. CMS implemented the new legislation by adjusting the CY 2023 conversion factor (CF) of $33.07 by 2.93 percent and the budget neutrality adjustment for a CY 2024 CF of $33.29 for dates of service March 9 through December 31.
CMS Guidance
Outpatient Institutional Providers: Find Out When to Split Claims for Updated Rates
If you submit outpatient claims (or inpatient ancillary claims reimbursed under Part B) that include Physician Fee Schedule pricing, you may want to split a single claim into two claims to get updated rates in certain situations.
Examples of these situations include when CMS:
- Applies the CY deductible
- Implements an off-cycle Physician Fee Schedule quarterly release
Affected type of bills:
- Hospital: 12X and 13X
- Skilled nursing facility: 22X and 23X
- Home health agency: 34X
- Outpatient rehabilitation facility: 74X
- Comprehensive outpatient rehabilitation facility: 75X