2014 Medicare Physician Fee Schedule Issues

It was recently brought to our attention that Novitas has yet to post the correct 2014 conversion factor for anesthesia. We also have concerns that the ambulatory surgery center and vaccine fee schedules are not up to date. MSNJ asked Novitas about the timeline for posting the corrected fee schedules. We were advised that they are in the process of updating the anesthesia conversion factor on the website. We are still awaiting information on the ASC and vaccine fee schedules.

Novitas also advised MSNJ that it has loaded the regular 2014 fee schedule and is prepared to accept 2014 claims. Novitas is still working on posting the 2014 physician fee schedule in the file formats that may be imported into billing software. For now, Novitas is posting the files in a basic text only format to give practices an opportunity to review the 2014 fees. Likewise, these fees are not yet available in Novitas’ interactive fee calculator.

We believe that if you bill Medicare less than the 2014 fee schedule amount, Medicare will pay the lesser amount based on past experience. Likewise, in the past, Medicare would not reconsider claims that were paid at a billed amount that is less than the current Medicare fee schedule. We have requested clarification on this issue from Novitas since it appears from the web site that these fees are up to date and physicians may have charged less than what they are entitled to through no fault of their own. To avoid this issue, physicians may want to consider billing Medicare at the practice’s regular fee schedule to ensure that the amount billed is above the Medicare fee schedule amount. Another option is to hold claims until the correct information is posted on the Novitas website.

Please stay tuned to e-News for more information as it becomes available.

About MSNJ

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

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