Maintenance Process for the Medicare Physician Fee Schedule Database

30.1 - Maintenance Process for the Medicare Physician Fee Schedule Database (MPFSDB) (Rev. 1, 10-01-03) The CMS calculates the fee schedule payment amounts and releases them to the A/B MACs (B) in the Medicare Physician Fee Schedule Database (MPFSDB). A/B MACs (B) implement those payment amounts on January 1 of each year. The CMS maintains the payment files centrally and is responsible for recalculating any revised payment amounts. Any revisions initiated by Central Office (fee schedule amounts or payment policy indicators) are issued to the A/B MACs (B) on a quarterly basis. The information for the ongoing maintenance of the MPFSDB is stated below. • CMS calculates the new fee schedule amounts. The CMS Central Office issues the revised data to the ROs in the same format of the MPFSDB. • A/B MACs (B) receive a file containing data with revisions for the quarter. This file is released electronically via CMS’ Mainframe Telecommunications System. • A/B MACs (B) must allow providers 30 days notification before revised payment amounts are implemented. The revised payment amounts are implemented the beginning of the following quarter. • CMS furnishes the recalculated payment amounts to the A/B MACs (B) in data files to ensure accuracy. A/B MACs (B) overlay these files into their existing file, to eliminate the potential for errors. • A/B MACs (B) must make adjustments on those claims that were processed incorrectly if the adjustment is requested by the physician/supplier. Adjustments are made retroactively to January 1 of the current year, unless otherwise specified. This directive applies in all instances unless the situation requires special consideration. In those instances, instructions on handling adjustments will be provided on a case-by-case basis. Separate instructions are issued describing the data exchange for the A/B MACs (A) and (HHH) • .In summary, A/B MACs (A) and (HHH) receive the revised payment amounts two to three weeks after the A/B MACs (B) receive the data from CMS. A/B MACs (A) and (HHH) do not implement the revised payment amounts prior to the A/B MACs (B)’s implementation date. • A/B MACs (B) are required to furnish the revised payment information to the State Medicaid Agencies upon their request one month following receipt of the data from CMS. Those State agencies with Internet access capability will download the data directly from CMS Web site. The CMS publishes a schedule for Medicare Physician Fee Schedule updates and participation physician enrollment procedures annually for all MACs.