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2016 Adjusted Medicare Prospective Payment System (PPS) Base Rate and Geographic Adjustment Factors (GAFs)


12/18/15

Synopsis
 
Effective January 1, 2016, the FQHC Medicare PPS base payment rate will increase from $158.85, the base payment for calendar year (CY) 2015, to $160.60. The CY 2016 base payment rate reflects a 1.1% increase from the base payment for CY 2015. This increase is in accordance with the growth rate of the Medicare Economic Index (MEI). Additionally, the CY 2016 GAFs have been updated based on the Geographic Practice Cost Index (GPCIs) used to adjust payments under the Medicare Physician Fee Schedule (MPFS). The adjusted GAFs may be accessed here.
 
What Does CohnReznick Think?
To prepare for the transition to the new CY 2016 payment rate, providers should determine if there is a change to their 2016 GAF, update their financial projections and reports to account for any shifts in expected reimbursement, and educate staff regarding changes in expected reimbursement rate effective for dates of service beginning January 1, 2016.  Medicare Administrative Contractors provide a tool to aid FQHCs in calculating GAF-adjusted PPS rate amounts.  Contact or visit the jurisdictional MAC to become familiar with this tool. The self-service tool for National Government Services (the MAC for Jurisdiction 6) is available here. After logging in, select FQHC > Provider Resources > Calculators & Tools and then select the appropriate file based on the date of service of the claim.
 
Contact
 
For more information, please contact Dolores DiRe, Manager, at dolores.dire@cohnreznick.com or 646-625-5703, or Peter Epp, Partner and Healthcare Industry Practice Leader, at peter.epp@cohnreznick.com or 646-254-7411.


This has been prepared for information purposes and general guidance only and does not constitute professional advice. You should not act upon the information contained in this publication without obtaining specific professional advice. No representation or warranty (express or implied) is made as to the accuracy or completeness of the information contained in this publication, and CohnReznick LLP, its members, employees and agents accept no liability, and disclaim all responsibility, for the consequences of you or anyone else acting, or refraining to act, in reliance on the information contained in this publication or for any decision based on it.

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