RESOLVED: Bipartisan Budget Act of 2018

Current Status
11/19/2019: Resolved. North Carolina and Virginia adjustments have been completed.

Issue Identified April 4, 2018
On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018 which contains a number of provisions that extend certain Medicare FFS policies, including Ambulance add-on payment provisions, the Work Geographic Practice Cost Index (GPCI) Floor, and the three percent Home Health (HH) Rural Add-on Payment. In addition, the Act permanently repeals the outpatient therapy caps beginning on January 1, 2018, while retaining the requirement to submit the KX modifier for services in excess of the prior cap amounts. Due to the retroactive effective dates of these provisions, Palmetto GBA is instructed to reprocess various Medicare FFS claims impacted by this legislation. Details regarding these provisions are outlined in
MM10531 (PDF, 236 KB).

Provider Action:
There is no provider action. Palmetto GBA is in the process of adjusting claims impacted by this legislation within the CMS allotted six-month time frame. This CPIL will be updated when all adjustments have been completed.

Status:
11/19/2019: Resolved.
North Carolina and Virginia adjustments have been completed.

10/31/2018: Jurisdiction M MPFS adjustments for West Virginia and South Carolina have been completed. Adjustments for North Carolina and Virginia are ongoing with more than 70 percent completed.

9/26/2018: Adjustments have been completed for affected anesthesia, ambulance and carrier priced services for all jurisdictions (Railroad and Jurisdiction J and M). Adjustments for affected Medicare Physician Fee Schedule (MPFS) services have been completed for Railroad and Jurisdiction J. This CPIL will be updated when adjustments for MPFS services have been completed for Jurisdiction M.

8/13/2018: Railroad Claims - It has been determined that this issue also affected claims for Railroad Medicare beneficiaries. The adjustments for Railroad claims have been made resolving this issue for Railroad claim submissions.

8/8/2018: Palmetto GBA continues to adjust the large volume of affected claims. This CPIL will be updated when all adjustments have been completed.

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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