Periodic Review

90.3.1 – Periodic Review (Rev. 13150; Issued:04-11-25; Effective: 01-01-25; Implementation:05-12-25) MACs must periodically review (at least every five years taking into account local conditions as appropriate) their locally determined payment amounts to consider whether their current payment amounts reflect the relative resources (e.g., staff, equipment, supplies and all indirect expenses) involved with performing MAC-priced services. Portable x-ray suppliers may work with the local MACs to review payment amounts for these services, including reporting cost data in the MAC’s requested format for their jurisdiction(s). MACs may request additional cost data from suppliers to aid in the periodic review process. The purpose of the MACs’ periodic review process is to obtain reported costs from suppliers for portable x-ray transportation services within the jurisdiction under review. Direct costs related to the vehicle carrying the x-ray machine are fully allocable to determining the payment rate. This includes the cost of the vehicle using a recognized depreciation method, the salary and fringe benefits associated with the staff who drive the vehicle, the communication equipment used between the vehicle and the home office, the salary and fringe benefits of the staff who determine the vehicles route (vehicle fuel, repairs and maintenance of the vehicle(s), insurance for the vehicle(s), operating expenses for the vehicles and any other reasonable costs associated with this service. The MAC will have discretion for allocating indirect costs (those costs that cannot be directly attributed to portable x-ray transportation) between the transportation service and the technical component of the x-ray tests using an established Medicare allocation method. The MACs must inform each supplier who submits such data that the data is subject to verification and will be used to supplement other information that is used to determine payment rates set by the MAC. The MACs must disclose the methodology and data sources used to set transportation rates following a periodic review. Suppliers are allowed ample time to respond to survey requests for use in the MAC periodic review process. If the periodic review will adjust rates for the upcoming calendar year, the MACs are allowed ample time to complete their review and inform suppliers of preliminary rates before the start of the upcoming calendar year. Mid-year adjustments are possible if the MAC believes such adjustments are appropriate based on a review and assessment of cost information submitted by portable x-ray suppliers. These mid-year adjustments provide MACs with the flexibility to take into account local factors affecting the level of resources involved with performing this service.