Think you are getting a 0.5% increase from CMS this year? Think again.

January 22, 2016

Your Real Payment Revenue Changes from CMS in 2016

By Mick Raich, President, Vachette Pathology

  • Thanks to a clause about budget goals, the 0.5% increase will not come to fruition
  • Comparing the new conversion rates reveal a true revenue decrease of -0.1%
  • To understand how this will impact your revenue, contact us today

Recently one of my most valued employees, Angela Granlund, Practice Manager Extraordinaire, came to me with a spreadsheet.  It showed the old conversion factor for the 2016 National Physician Fee Schedule which was released on 11/10/2015, compared to the new conversion factor for 2016 which was released on 1/5/2016.

Remember that 0.5% increase all providers were supposed to get because we did away with the Standard Growth Rate formula?  Well…as expected you will not be seeing this.

In the federal register, where this concept was released, there was a little clause on page 714 that stated if the government did not reach their budget goals, then the increase will not take place.

So here is what really is happening. On the November 10th release of the 2016 National Physician Fee Schedule Relative Value File, the conversion factor was 35.8279.  On the January 5th release of the 2016 National Physician Fee Schedule Relative Value File, the conversion factor was 35.8043.

This means overall your rates drop from a 0.5% increase to a 0.1% decrease.

To see how it breaks down by CPT code, download our comparison PDF:

Comparison of National CMS Rates

[contact-form-7 id=”1126″ title=”CMS National Rates Comparison” html_id=”CMS_Rates_2016″]

If you have questions on this and want to look at your true pathology or laboratory revenue, please feel free to give me call at Vachette Pathology, 517-486-4262.  I will do my best to help.

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