The AAFP government relations team is seeking your feedback on two issues related to the ongoing federal government shut down and how it is impacting Medicare claims.
First, the GPCI work floor:
As you know, this policy ensures that the Geographic Practice Cost Index (GPCI) for physician work does not fall below a statutory minimum, helping maintain payment levels in lower-cost areas. Unfortunately this policy has lapsed and there was confusion over whether CMS was holding all claims for these regions, or whether they were processing claims at the lower rate.
Second, telehealth claims:
We have also heard anecdotally that certain claims processing issues have occurred as a result of the telehealth claims hold. One member indicated that because telehealth claims were not being processed, orders or prescriptions originating in those visits are being denied as MACs do not have a record of the visit occurring. For example, during a telehealth visit, a physician orders DME for a patient. When the patient tries to acquire the DME, their claim is denied because the MAC has no record of their telehealth visit due to the claims hold.