revised version of RBRVS EZ-Fees
for 2015 is available for immediate download.
Health Professionals: Information Regarding the Medicare
Access and CHIP Reauthorization Act of 2015
April 14, 2015, Congress passed the Medicare Access and
CHIP Reauthorization Act of 2015; the President is
expected to sign it shortly. This law eliminates the
negative update of 21% scheduled to take effect as of
April 1, 2015, for the Medicare Physician Fee Schedule.
In addition, provisions allowing for exceptions to the
therapy cap, add-on payments for ambulance services,
payments for low volume hospitals, and payments for
Medicare dependent hospitals that expired on April 1
have been extended. CMS will immediately begin work to
implement these provisions.
an effort to minimize financial effects on providers,
CMS previously instituted a 10-business day processing
hold for all impacted claims with dates of service April
1, 2015, and later. While the Medicare Administrative
Contractors (MACs) have been instructed to implement the
rates in the legislation, a small volume of claims will
be processed at the reduced rate based on the negative
update amount. The MACs will automatically reprocess
claims paid at the reduced rate with the new payment
action is necessary from providers who have already
submitted claims for the impacted dates of
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1998, RBRVS EZ-Fees has helped thousands of health care professionals simplify
the Medicare payment formula. With a few clicks you can create
medical fee schedules without
government downloads or
complicated formulas. Most users have mastered
our software in 5 minutes!
customers include: physicians and other
providers, office managers, insurance
companies and other providers (HMO, PPO,
TPA, PHO, IPA), CFOs, CEOs,
CPAs, consultants, state and federal
agencies, medical societies, associations,
payers, billing services, accountants,
actuaries, lawyers, life care planners
and other healthcare professionals.
comes with all *CPT / HCPCS codes,
descriptions, unit values, GPCIs,
conversion factor (CF) preloaded. *A licensed AMA CPT product.
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EZ-Fees is a low cost, easy-to-use
(Windows) software program that creates
and analyzes physician payments using
Medicare's RBRVS (Resource Based
Relative Value Scale).
All US localities included.
is not just for Medicare.
to the AMA, RBRVS is widely used in non
Medicare medical reimbursement including
managed care and private insurance.
Most states' worker compensation boards
including California have adopted RBRVS as their payment
model due to its universal acceptance.
CMS (coding and fee updates are
FREE with RBRVS EZ-Fees for the Fiscal
Year. Visit our update
page for simple download
can export fees, unit values, codes,
descriptions and notes for over 10,000
CPT/HCPCS codes to Excel, ASCII, Lotus
or dBASE or print custom reports.
includes 5 user defined fee and
per session. Allows for unlimited
EZ-Fees is so easy-to-use there is only
one main screen and no technical manual!
(free technical support if needed)
be fooled by our low price ($199) -
RBRVS EZ-Fees has all the features plus
many more (utilization manager and
specialty tagging) found in other
software packages costing hundreds more.
603 - Extension Related to Payments for Medicare
Outpatient Therapy Services
603 extends the exceptions process for outpatient
therapy caps through December 31, 2013. Providers
of outpatient therapy services are required to submit
the KX modifier on their therapy claims, when an
exception to the cap is requested for medically
necessary services furnished through December 31, 2013.
In addition, the new law extends the application of the
cap and threshold to therapy services furnished in a
hospital outpatient department (OPD), and counts
outpatient therapy services furnished in a Critical
Access Hospital towards the cap and threshold.
Additional information about the exception process for
therapy services may be found in the Medicare Claims
Processing Manual, Pub.100-04, Chapter 5, Section 10.3:
therapy caps are determined for a beneficiary on a
calendar year basis, so all beneficiaries began a new
cap for outpatient therapy services received on January
1, 2013. For physical therapy and speech language
pathology services combined, the 2013 limit for a
beneficiary on incurred expenses is $1,900. There
is a separate cap for occupational therapy services
which is $1,900 for 2013. Deductible and
coinsurance amounts applied to therapy services count
toward the amount accrued before a cap is reached, and
also apply for services above the cap where the KX
modifier is used.
603 also extends the mandate that Medicare perform
manual medical review of therapy services furnished
January 1, 2013 through December 31, 2013, for which an
exception was requested when the beneficiary has reached
a dollar aggregate threshold amount of $3,700 for
therapy services, including OPD therapy services, for a
year. There are two separate $3,700 aggregate
annual thresholds: (1) physical therapy and
speech-language pathology services, and (2) occupational
604 - Extension of Ambulance Add-On Payments
604 extends the following three Job
Creation Act ambulance payment provisions:
(1) the 3 percent increase in the ambulance fee schedule
amounts for covered ground ambulance transports that
originate in rural areas and the 2 percent increase for
covered ground ambulance transports that originate in
urban areas is extended through December 31, 2013; (2)
the provision relating to air ambulance services that
continues to treat as rural any area that was designated
as rural on December 31, 2006, for purposes of payment
under the ambulance fee schedule, is extended through
June 30, 2013; and (3) the provision relating to payment
for ground ambulance services that increases the base
rate for transports originating in an area that is
within the lowest 25th percentile of all rural areas
arrayed by population density (known as the “super
rural” bonus) is extended through December 31, 2013.
is currently revising the 2013 Medicare Ambulance Fee
Schedule (MAFS) to reflect the new law’s
requirements. In order to allow sufficient time to
develop, test, and implement the revised MAFS, Medicare
claims administration contractors may hold MAFS claims
with January 2013 dates of service for up to 10 business
days (i.e., through January 15, 2013). We expect
these claims to be released into processing no later
than January 16, 2013. The claim hold should have
minimal impact on supplier cash flow because, under
current law, clean electronic claims are not paid sooner
than 14 calendar days (29 for paper claims) after the
date of receipt. Claims with dates of service
prior to January 1, 2013, are unaffected.
of ambulance services affected by these provisions may
continue billing as usual.
605 - Extension of Medicare Inpatient Hospital Payment
Adjustment for Low-Volume Hospitals
Care Act allowed qualifying low-volume
hospitals to receive add-on payments based on the number
of Medicare discharges. To qualify, the hospital
must have less than 1,600 Medicare discharges and be 15
miles or greater from the nearest like hospital.
This provision extends the payment adjustment through
September 30, 2013, retroactive to October 1, 2012.
Be on the alert for further information about
implementation of this provision.
606 - Extension of the Medicare-Dependent Hospital (MDH)
MDH program provides enhanced payment to support small
rural hospitals for which Medicare patients make up a
significant percentage of inpatient days or discharges.
This provision extends the MDH program until
October 1, 2013, and is retroactive to October 1, 2012.
Be on the alert for further information about
implementation of this provision.
CMS released a revised version of RBRVS to fix
'Technical Problems'. This translates to a new CF
(Conversion Factor), revised RVUs, new codes and other
new revised 2015 Conversion Factor
is $35.7547 not $35.8013 as previously released
by CMS and RBRVS EZ-Fees V1.0 (See Help About).
Unless there are more problems this new fix this update
should stay in effect through March 31 when the SRG
November 13, 2014, the CY 2015 Medicare Physician Fee
Schedule (MPFS) final rule was published in the Federal
Register. In order to implement corrections to technical
errors discovered after publication of the MPFS rule and
process claims correctly, Medicare Administrative
Contractors will hold claims containing 2015 services
paid under the MPFS for the first 14 calendar days of
The hold should have minimal impact on provider cash
flow as, under current law, clean electronic claims are
not paid sooner than 14 calendar days (29 days for paper
claims) after the date of receipt.
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