Medicare Part B Rates
Last month, LeadingAge New York provided members with a detailed analysis of the Medicare Physician Fee Schedule (MPFS) for the first quarter of Calendar Year (CY) 2015. The MPFS includes Medicare Part B rates paid to nursing home and home health agencies for ancillary services. LeadingAge NY's analysis includes:
- a listing of rates for the first quarter of 2015 for the most commonly used ancillary services;
- a link to the LeadingAge national Medicare Part B rate calculation tool; and
- the latest on Therapy Caps and the exceptions process.
This is a reminder that for the first quarter of CY 2015, Medicare Part B rates remain essentially unchanged from CY 2014, with a slight adjustment in the conversion factor from $35.8228 (CY 2014) to $35.8013 (CY 2015). This is the result of legislation (Pathway for SGR Reform Act of 2013) that extended last year’s rates into the first quarter of 2015. This means that Wed., April 1, 2015 will be the effective date for any new rates stemming from the MPFS final rule issued last November.
Last year, the Centers for Medicare and Medicaid Services (CMS) released a fact sheet on the MPFS for 2015. As currently posted, the MPFS includes an average 21.2 percent reduction in rates effective April 1, 2015.
Members are advised that for several years now, CMS has been mandated to publish initial Medicare Part B rates that include a significant reduction based on the current Sustainable Growth Rate formula (SGR). Policy and lawmakers generally acknowledge that the SGR methodology is flawed and Congress has always intervened to override the otherwise negative rate adjustments.
It is important for providers to watch for further developments in terms of a Congressional override of the currently scheduled 21.2 percent reduction in rates effective April 1, 2015. LeadingAge is advocating for Congress to act to avert a major reduction in rates. LeadingAge NY will keep members informed of further developments.
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827