New Bipartisian Budget Act of 2018 Provisions

March 1st, 2018 - Wyn Staheli, Director of Research
Categories:   Modifiers   Medicare  
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On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. There were some changes which will affect Medicare payments. The following is a brief summary, for a more comprehensive summary see the References.

  • Therapy Caps: Some therapy caps (e.g., occupational, physical therapy, speech-language pathology) were discontinued. However, modifier KX will be required to indicated the services are medically necessary and there will be medical reviews when services exceed $3,000 per year.
  • Geographic Practice Cost Index (GPCI): The work portion of the GPCI has a floor of 1.000 through December 31, 2019. This may affect your payments if you were in an area with a lower work 'floor'. Find-A-Code has the updated fee calculations (see the [Fees] section for each individual code.) If you haven't done a fee analysis for the year, perhaps now would be a good time to use our Compare-A-Fee tool.
  • Ambulance Services: Two provisions were extended - fee and base rate increases. Also non-emergency ESRD payment rates were reduced.
  • Low-Volume Hospitals: Extension of the law which allows qualifying low-volume hospitals to receive add-on payments based on their number of discharges and their distance from the nearest hospital.
  • Medicare-Dependent Hospital (MDH) Program: Extension of the MDH program which enhances payments to qualifying small rural hospitals.
  • Home Health: Extension of the 3 percent payment add on (in 2018) for home health services provided in a rural area. For 2019, the add on will vary by the location and the type of services provided.
  • Skilled Nursing Facilities: The payment update portion is holding for an estimated market basket update. Watch for further proposed rulemakings on SNF payments.

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