APDA ACTION ALERT
Dear APDA Members and Industry Partners,
This APDA Action Alert contains two important updates:
(1) Novitas reassessment of portable x-ray (PXR) transportation rates in Jurisdictions JH and JL, and (2) an action alert for providers to engage with their elected representatives and state-based stakeholders to secure a 10% transportation fee increase in ALL states and a pause in any MAC rate reviews due to the COVID-19 pandemic.
APDA has prepared instructions to assist you with this grassroots effort and we are asking providers in ALL states to reach out to their Members of Congress.
R-Code Changes in Novitas Jurisdictions JH/JL
As you are aware, Novitas is currently reevaluating the transportation payment rates for PXR in the following states: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, Delaware, Maryland, New Jersey, Pennsylvania, and the District of Columbia.
APDA Leadership along with the Dumbarton Group, convened a conference call with Novitas principals last week. This update covers some initial thoughts about what transpired between the APDA team and Novitas decision-makers.
During our call, APDA firmly stated our position that Novitas should:
- Maintain current rates until such time as new adequate rates for each state can be developed
- Ensure Medicare beneficiaries maintain access to timely portable x-ray services
- Create determinate, predictable reimbursement for providers
- Reject a “flat rate” application and take into consideration real variances between the 11 states and District of Columbia
While this issue remains fluid and the final outcome is unclear at this time, APDA’s meeting with Novitas resulted in the following:
- Novitas was complimentary about APDA’s collection efforts and our ability to increase industry participation with submitting detailed data
- Novitas confirmed the March 31, 2020 data collection period was still intact
- Novitas requested APDA to secure additional PXR companies cost data to increase industry participation
- Novitas would continue to work with APDA and other stakeholders during the review process
- Novitas provided the following timeline they will likely follow:
- Data collection period will expire on March 31, 2020
- Novitas will take 30-60 days to review data it received from all industry providers
- After a comprehensive review, Novitas will release new rates for each of the 11 states and DC
- Once the new rates are announced, the effective date will most likely begin 6 weeks from the date of the announcement
- Novitas indicated a single “flat rate” across all 11 states and DC would NOT occur. Novitas acknowledged there are geographic and demographic differences that create unique costs for each state.
During the meeting, APDA also reviewed a joint ADPA/National Association for the Support of Long-Term Care (NASL) letter to CMS on COVID-19 where we call upon CMS to:
- Immediately provide a 10% increase to PXR transportation rates in all Medicare jurisdictions while heightened infection control procedures are in place, and
- Pause all current Medicare Administrative Contractors (MAC) action on the reevaluation of PXR transportation rates for no less than six months or until the COVID-19 outbreak subsides.
We anticipate meeting with CMS, along with our allied stakeholders, to press for action on both the R-code and a fee increase due to COVID-19.
Action Items for APDA Members
APDA is asking all members to remain engaged in grassroots efforts to promote the new phase of this initiative and we have prepared instructions to assist you. We are specifically asking members to:
- Contact your respective Members of Congress and ask them to reach out to CMS and promote:
- Providing a 10% increase to PXR transportation rates in all Medicare jurisdictions while heightened infection control procedures are in place
- Pausing all current Medicare Administrative Contractors (MAC) actions on the reevaluation of PXR transportation rates for no less than six months or until the COVID-19 outbreak subsides.
- Reach out to state stakeholders and ask if they will write CMS and promote our new requests as stated above.
APDA remains hopeful with resolute efforts of our members and industry partners we can receive a positive outcome and secure rates that are palatable to all 50 states. APDA will continue to update members on this fluid issue that has a tremendous impact to our industry.