As you are aware, On December 27th, there was a Correction Notice issued relevant to the CY 2018 Outpatient Prospective Payment System. Of note, it addressed technical errors in the Final Rule that affected three vascular codes (93880, 93930 and 93978). These codes were moved from APC 5522 to APC 5523 changing the payment rates effective January 1st. This also affected the Part B Physician Fee Schedule, since these codes are capped by the APC rates.
In January, SVU began receiving inquiries from members who provided vascular services, submitted claims and felt they were being underpaid. At that time, SVU began working with the Medicare Administrative Contractors (MACs) and directors at the Centers for Medicare & Medicaid Services (CMS). CMS confirmed they were aware of the incorrect files and assured us they were working on a resolution. For the last several months, SVU has been working tirelessly with members, Bill Sarraille (SVU’s regulatory counsel), and leaders from the Society for Vascular Surgery on this issue.
On March 19th, SVU and SVS spoke with directors from CMS’ Practitioner Claims Processing and Practitioner Services groups. I am happy to report, CMS confirmed all providers are being paid from the corrected fee schedules and claims processed today should be paid correctly. In addition, CMS will be providing guidance to the contractors about claims reprocessing. This information should be available this week.
Thank you to members who provided claims data and examples of incorrect payment files. This really helped us get a quicker resolution. Please continue to reach out to SVU if you have any questions or concerns.