2010 Medicare Fee Schedules

Drastic Cuts Temporarily Reversed By Congress

We are pleased to provide you with the Medicare Fee Schedules for Ohio effective January 1, 2010. As anticipated, Congress passed the Department of Defense Appropriations Act of 2010 which granted a two-month temporary reversal of the expected 21.5% cut to payments for Medicare Part B services. The legislation provided for a slight increase in payment for most Part B billing codes. We will keep you updated as to whether the reversal of the cuts becomes permanent.

It is important to forward the fee schedules to your business office personnel to use for January bills. The schedules are available in PDF format in the links below.

Our Revenue Cycle Consultants are available to assist with any billing questions you may have. In addition, if you use PointClickCare, we can electronically upload the fee schedules for you. Please contact your HW Healthcare Advisor if you need additional codes, fee schedules for any other states, or if you would like a copy of the schedules in Excel format.

Many of the fee schedules change or are updated on a quarterly basis.  Please review the appropriate schedule based on the Centers for Medicare & Medicaid Services (CMS) updates. Check the CMS website on a regular basis for updates to these schedules. Please note that these schedules are not all inclusive. We have attempted to limit this information to the most commonly used Healthcare Common Procedure Coding System (HCPCS) codes for long-term care facilities.

Many providers use only the therapy fee schedules. We have provided the lab, radiology, PEN and DMEPOS schedules in order to help you identify potential cost savings for your Medicare Part A and Managed Care residents. The fee schedules may be useful in negotiating and verifying the rates being paid to ancillary services providers and will provide guidance to ensure you are paying a cost effective rate.

Ohio Medicare Part B Fee Schedules

1. Medicare Part B Therapy
2. Radiology
3. Clinical Diagnostic Laboratory
4. Parenteral & Enternal Nutrition Items & Services  (PEN) – National
5. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items:
   1. Prosthetics and Orthotics
   2. Ostomy, Tracheostomy & Urology
   3. Surgical Dressings
   4. Supplies
   5. DME: Non-billable, Part B by SNF

If you have any questions on these or other issues facing your facility, please feel free to contact your Howard, Wershbale & Co. health care professional, or visit us online for more information on our Health Care Advisors.

Therapy Caps Now In Effect!

Both the House and Senate versions of the health care reform bill contain provisions to extend the therapy cap exception process. However, since a final bill was not signed into law by December 31, 2009, the $1,860 cap for occupational therapy and the combined cap for speech and physical therapies are now in effect. If legislative action is not taken to retroactively extend the caps, Medicare will not pay for services billed above the cap. You should contact your therapy provider to be sure that they are prepared for the caps.  

CMS has issued an MLN Matters article providing facilities with direction on dealing with the therapy caps. It is widely expected that Congress will pass an extension of the therapy cap exception process retroactive to January 1, 2010. CMS has suggested that providers, if possible, hold January Part B claims until it is clearer as to whether the exceptions process will be extended. We will keep you informed of any key developments related to the therapy caps and other health care reform provisions.

2010 Medicare Part A Co-Insurance and Medicare Part B Premium and Deductible

We communicated the new Medicare co-insurance, premium and deductible amounts in a prior E-Blast. Since they are now effective, we wanted to remind you of the changes. Effective January 1, 2010, the Medicare Part A co-insurance rate for SNFs will increase to $137.50 per day for days 21 through 100.  The Part B deductible will increase to $155.00 per year. The Medicare Part B monthly premium for most beneficiaries will remain at $96.40 since the premium will not increase for beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less ($170,000 or less for joint filers).  New Part B beneficiaries and those that do not currently have the Part B premium withheld from their Social Security benefit will pay $110.50, which is a 15% increase over the 2009 premium.  If income exceeds $85,000 (single) or $170,000 (married couple), the Medicare Part B premium may be higher than $110.50 per month.