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CMS Releases Updated Adjustments for July 2016 Retroactive Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has released update fee schedules for the July 2016 adjustment for rural and non-bid areas, which the 21st Century Cures Act authorized late last year. 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 and 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:

This reaffirms the need for immediate long-term reforms to the competitive bidding program as the program has proven to be unsustainable. VGM will continue to fight these reductions and we will continue the pressure on Congress and CMS to find real solutions to this highly flawed program.