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Call to Action: Continuing the Fight for Sustainable Rates

With yesterday’s release of the update fee schedules for the July 2016 adjustment for rural and non-bid areas, previous estimates have been confirmed that providers were hoodwinked by CMS.

As expected, CMS adjusted the new rates by including prices from the most recent round of competitive bidding. Including the additional round of competitive bidding has reduced the reimbursement that is owed to providers by an additional 6-11 percent, depending on the location and product.

“CMS incorporating July 1 competitive bidding rates into the retroactive payment that providers are owed goes directly against the intent of Congress to provide relief to rural providers who are struggling,” said John Gallagher, VP of VGM Government Relations.

To give providers an idea of what these cuts look like, we have compiled a chart to illustrate the differences in reimbursement and where they are now. Below are the average rates of most commonly used codes in the contiguous United States:

While “something is better than nothing” comes to mind, this clear misapplication of the intent of the Cures Act by CMS is unacceptable. Providers must call their members of Congress to sound the alarm on these constant rate reductions. Many congressional offices know long-term reforms must be made to the competitive bidding program, but they have to hear from constituents about the problems they face. This kind of grassroots outreach is what has garnered such broad bipartisan support from Congress in recent years.

Call your members of Congress through the U.S. Captiol Switchboard at (202) 224-3121.

John Gallagher and Mark Higley will be discussing these latest developments, what the future of competitive bidding might look like, and where there are opportunities for providers to fill the void from unsustainable reimbursement rates. For more information visit: