January 2007
Provider Types Affected
Providers submitting claims to Medicare Fiscal Intermediaries (FIs) and/or Part A/B Medicare Administrative Contractors (A/B MACs) for services provided to Medicare beneficiaries.
What You Need to Know
This article is based on Change Request (CR) 5435 which provides instructions for the Calendar Year (CY) 2007 Payment Rate Increases for RHC and FQHC services. The RHC upper payment limit increase per visit is $74.29 and reflects a CY 2007 rate increase of 2.1 percent. The FQHC upper payment limits per visit also reflects a CY 2007 rate increase of 2.1 percent for urban ($115.33) and rural ($99.17) areas.
Background
The following provides instructions for the CY2007 Payment Rate Increases for RHC and FQHC services.
RHCs:
The RHC upper payment limit per visit is increased
The 2007 rate reflects a 2.1 percent increase over the 2006 payment limit in accordance with the rate of increase in the Medicare Economic Index (MEI) as authorized by the Social Security Act (§1833(f); http://www.ssa.gov/OP_Home/ssact/title18/1833.htm).
FQHCs:
The FQHC upper payment limit per visit for urban FQHCs is increased:
The maximum Medicare payment limit per visit for rural FQHCs is increased:
The 2007 FQHC rates reflect a 2.1 percent increase over the 2006 rates, in accordance with the rate of increase in the MEI.
Additional Information
The official instruction, CR5435, issued to your FI and A/B MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1126Cp.pdf on the CMS website.
If you have any questions, please contact your state's Provider Contact Center.
MLN Matters 5435