MiraVista continues to monitor for the public posting of the Medicare fee schedule update. The new pricing will take effect on July 1, 2016. In this next update, providers will see the full realization of national pricing cuts derived from competitive bid pricing. HCPCS previously subject to any round of bidding will see significant rate reductions across non-bid areas of the country beyond the reductions seen in January. The January 2016 update presented partial rate reductions… weighting 50% for unadjusted pricing and 50% from averaged pricing derived from prior rounds of contracting.
Per a recent communication with CMS, the pricing files have been created and shared with the MACs. However, a few discrepancies were identified in the original file and targeted for correction before releasing to the public. CMS hopes to post the fee schedules toward the end of this week, just days away from when the new pricing will take effect. The official July rates could not be calculated before the Round 2 Recompete (R2RC) Single Payment Amounts (SPAs) were announced late in March. The R2RC SPAs presented us with even lower rates than prior competitions. Although not significantly less, these reductions will further depress the July rates. With the exception of infusion products, several items that received a more favorable rate calculation (due to pricing derived from limited competitions at the time of the January posting) will now be subject to the full roll out.
As soon as the final rates are posted, MiraVista will bring you a breakdown comparison of common products in the respiratory, enteral, mobility and DME categories to fully materialize the July rates compared to the prior January 2016 and 2015 reimbursements. While not desirable, take heart that contracted providers have been operating under these rates for several years. DME operations need to be mindful of the rate changes to fully appreciate return on investment and accurately project profitability scenarios. Beyond pricing, DMEs must aggressively pursue efficiencies at every turn to remain viable. Reduction of touch points within your operations is not a luxury, it is essential. If you are struggling with inefficiencies, please contact our office. We can help. Call (803) 462-9959 ext. 240 and let's start the conversation today.
Per a recent communication with CMS, the pricing files have been created and shared with the MACs. However, a few discrepancies were identified in the original file and targeted for correction before releasing to the public. CMS hopes to post the fee schedules toward the end of this week, just days away from when the new pricing will take effect. The official July rates could not be calculated before the Round 2 Recompete (R2RC) Single Payment Amounts (SPAs) were announced late in March. The R2RC SPAs presented us with even lower rates than prior competitions. Although not significantly less, these reductions will further depress the July rates. With the exception of infusion products, several items that received a more favorable rate calculation (due to pricing derived from limited competitions at the time of the January posting) will now be subject to the full roll out.
As soon as the final rates are posted, MiraVista will bring you a breakdown comparison of common products in the respiratory, enteral, mobility and DME categories to fully materialize the July rates compared to the prior January 2016 and 2015 reimbursements. While not desirable, take heart that contracted providers have been operating under these rates for several years. DME operations need to be mindful of the rate changes to fully appreciate return on investment and accurately project profitability scenarios. Beyond pricing, DMEs must aggressively pursue efficiencies at every turn to remain viable. Reduction of touch points within your operations is not a luxury, it is essential. If you are struggling with inefficiencies, please contact our office. We can help. Call (803) 462-9959 ext. 240 and let's start the conversation today.
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