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Tags Posts tagged with "Fee Schedule"

Fee Schedule

ODP Announcement 22-007: UPDATE provides information to providers in order to prepare for upcoming rate increases that are scheduled to be published in the Pennsylvania Bulletin on February 26, 2022.

Per the final public notice for Fee Schedule Rates, Department-established fees, and the AWC FMS Department-established fees rendered through the Consolidated, Community Living (CLW), and Person/Family Directed Support (P/FDS) waivers:

  • The anticipated effective date for the increased Fee Schedule Rates is January 1, 2022; however, the effective date in the Home and Community Services Information System (HCSIS) will be March 1, 2022.
  • The anticipated effective date for the Department-established fees for residential ineligible services is July 1, 2022, and HCSIS will reflect the same effective date.
  • Both the Fee Schedule Rates and Department-established fees for residential ineligible services will be visible in HCSIS on February 28, 2022. Compensation will be for the period January 1, 2022–February 28, 2022. The updated fee schedule rates will not be loaded in ISPs for the period January 1, 2022–February 28, 2022. Instead, the current rate will remain for that period, and ODP will be compensating providers, via gross adjustments, for the difference between the rate billed and the updated fee schedule rate for dates of service rendered during the period January 1, 2022–February 28, 2022. This is intended to eliminate the provider’s effort of voiding and rebilling claims.

ODP anticipates processing gross adjustments during the April to May 2022 timeframe to ensure all billing for dates of service January 1, 2022–February 28, 2022 has been completed. Providers are strongly encouraged to bill in a timely manner to minimize the need for corrections.

Since the new rates will have a begin date of March 1, 2022, two service/rate segments in authorized status will be present on ISPs, assuming no errors set. One service/rate segment will reflect the period July 1, 2021, to February 28, 2022, or the begin date of the service when it was initially authorized on the plan during Fiscal Year (FY) 2021–2022. The second service/rate segment will reflect the period March 1, 2022, to June 30, 2022.

Authorized units on the first service/rate segment, July 1, 2021–February 28, 2022, will reflect 67% of total authorized units for the FY 2021–2022. The second service/rate segment will reflect 33% of total authorized units for the remainder of FY 2021–2022. If an individual requires more than 33% of the total annual authorized units for the remainder of FY 2021–2022, a revision to the plan will be necessary to move units from the first service segment to the second service segment on the ISP. For the period July 1, 2021, to February 28, 2022, providers should bill normally for any services rendered.

See the ODP Announcement for the full instructions.

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The Centers for Medicare & Medicaid Services (CMS) has approved the Pennsylvania Department of Human Services’ (DHS) proposed minimum rates for each ASAM level of care. The rates are effective Jan. 1, 2022. According to DHS, the behavioral health managed care organizations must increase the rate being paid to any provider currently below the minimum. Providers being paid above the minimum will not be reduced to the minimum.

The rates have been posted and can be accessed through DHS’ website under “Behavioral HealthChoices Provider Resources.”

RCPA will share any additional information on the minimum rates as it becomes available. Please contact RCPA Drug and Alcohol Division Director Jason Snyder with any questions.

The Office of Long-Term Living (OLTL) has updated the Home and Community-Based Services (HCBS) Medical Assistance (MA) Fee Schedule. The updates reflect the fee schedule rates for Personal Assistance Services (PAS) procedure codes W1793, W1793 TT, W1792, and W1792 TU in the referenced Pennsylvania Bulletin below.

The updated OLTL HCBS MA Fee Schedule (effective January 1, 2022) may be found here. The new rates for the OBRA Waiver and Act 150 Program were announced in the Pennsylvania Bulletin on November 6, 2021, in the Volume 51, Number 45 issue and can be found here.

Questions related to this update should be directed to the OLTL Provider Inquiry Line at 800-932-0939, option 2, Monday–Friday between 9:00 am–12:00 pm and 1:00 pm–4:00 pm.

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The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. Some of the key provisions contained in this final rule include:

Telehealth Services

CMS finalized a policy to allow for Category 3 telehealth services to be available to providers through December 31, 2023. Category 3 telehealth services are those services CMS has added temporarily to the telehealth list due to the public health emergency (PHE) but wishes to consider for permanent addition to the telehealth list. Presently, many occupational and physical therapy services are on the Category 3 list, with some exceptions. However, CMS has not yet added any speech-language service codes to the Category 3 list, so their availability will cease at the end of the PHE. The current list of available telehealth codes is available here.

Therapy Services

CMS made final modifications to its policy for implementing a 15 percent payment reduction for outpatient therapy services provided in part by a therapy assistant, effective January 1, 2022. As previously finalized, any billed unit of service in which a therapy assistant independently provided more than 10 percent of the minutes of service must include a claim modifier and will be subject to the payment reduction. In this final rule, CMS slightly loosened the requirements, allowing providers to forgo appending the modifier for “remaining units” when the therapist had provided at least 8 minutes of the remaining unit, regardless of any additional minutes provided by the therapy assistant. CMS has provided numerous billing scenarios in the final rule to help explain the steps providers should take to determine when the modifier should be used. This guidance will be posted on CMS’ website.

Billing of Shared Services With a Physician Assistant (PA) or Nurse Practitioner

CMS finalized its proposed policy regarding the billing of services when both a physician and non-physician practitioner (NPP), such as a physician assistant (PA) or nurse practitioner (NP), share in the provision of a service. CMS will require the practitioner who performed the majority of the minutes relating to the service to bill for the service. Therefore, when an NPP provides more than 50 percent of the time for a given service, the NPP must bill for the service, and payment will be made at the lower applicable rate for that billed code. This policy applies to all Evaluation and Management (E/M) services provided in institutional settings, including hospitals.

CY 2022 PFS Rate-Setting and Conversion Factor

CMS finalized a series of standard technical proposals involving practice expense, including standard rate-setting refinements, the implementation of the fourth year of the market-based supply and equipment pricing update, and changes to the practice expense for many services associated with the update to clinical labor pricing. CMS finalized their proposal to update the clinical labor rates for CY 2022 through the addition of a four-year transition period as requested by public commenters.

The final rule will be published in the November 19, 2021 Federal Register.