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Experience. Integrity. Advocacy.

Restored Work GPCI Floor Means More Money — and Hassle — for Medicare Providers

One provision of the Bipartisan Budget Act of 2018, enacted February 9, 2018, will give Indiana providers a little extra revenue under the Medicare Physician Fee Schedule. It might also give them an extra little headache as WPS-GHA, Indiana’s Medicare Administrative Contractor (MAC), applies the changes retroactively to the first few weeks of the year.

Under the Act, the Work Geographic Practice Cost Index (GPCI) Floor, which was temporarily set to 1.0 under MACRA and allowed to expire as scheduled on December 31, 2017, was extended through December 31, 2019. Several Medicare localities, including all of Indiana, had benefited from the original MACRA provision, which increased any work GPCI below 1.0 up to 1.0. Medicare payments are calculated by locality using the GPCIs. The formula for setting Medicare payment rates is as follows: Payment = ( [Work RVU x Work GPCI] + [PE RVU x PE GPCI] + [MP RVU x MP GPCI]) x Conversion Factor). Each year, any of the variables can change, impacting the fee schedule. Specifically for 2018, the GPCIs for Indiana changed as follows:

2017 1.000 0.920 0.498
2018 (originally) 0.969 0.919 0.379
2018 (revised) 1.000 0.919 0.379

According to WPS-GHA, the fee schedule was updated on February 16, 2018, and would have been applied correctly for all 2018 DOS claims processed after that time. However, since the Bipartisan Budget Act changed the Work GPCI floor retroactively, any 2018 DOS claims processed prior to that time would have to be reprocessed. In fact, Change Request 10531 from the Centers for Medicare and Medicaid Services (CMS) directed MACs to begin automatically reprocessing claims on April 2 that had previously processed without the Work GPCI floor. On April 4, 2018, WPS-GHA reported that they had begun to reprocess those 2018 claims.

The reprocessed claims will include slightly higher allowed amounts for providers. Fortunately, that will result in a reversal of part of the Medicare write-off, and it may mean additional payment from Medicare. Unfortunately, it also likely will include additional amounts applied to the Medicare beneficiaries’ copayments and deductibles.

So in addition to Medicare reprocessing claims, this change likely will result in numerous claims being reprocessed by supplemental payers, along with extra work for billing departments to record the changes, post new payment and write-off amounts, send additional statements to patients for the new balances, and field phone calls from confused beneficiaries.

For more information about the restored work GPCI floor and other changes implemented under the Bipartisan Budget Act of 2018, review the MLN Matters Number: MM10531.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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