Nursing home providers in 11 states and Washington, D.C., may have to send more residents to the hospital to undergo X-rays, if a change from a Medicare Administrative Contractor goes into effect this spring.
That is because Novitas Solutions Inc., a MAC, may reduce transportation rates for portable X-ray suppliers starting on April 1. It initially was going to update the rates in late 2019 but postponed this change as it awaits additional survey responses on transportation cost information from radiology providers, the company said in a December disclosure.
“What Novitas is trying to do is make the rate uniform in all 11 states,” Cynthia Morton, executive vice president for the National Association for the Support of Long-Term Care, told McKnight’s Long-Term Care News. “They ratcheted the rate so low that the impact would be that some suppliers, in fact a lot, would have to make their service area smaller.”
A reduction in the transportation rates could mean that portable X-ray suppliers might limit or eliminate altogether their hours of operation for nursing homes, which then might be forced to send residents to the hospital for X-rays, she said.
“The nursing home would have to make a call: Do I send the patient to the hospital and get an X-ray there? The nursing home would have to pay for the patient to go to the emergency room, and sometimes they get admitted,” Morton said, noting that facilities are under pressure from the Centers for Medicare & Medicaid Services to reduce hospitalizations and rehospitalizations.
The rate reductions that were set to take effect at the end of 2019 ranged from 15% in Mississippi to 56% in Colorado, Morton said. The other states whose rates are in question are: Arkansas, Delaware, Louisiana, Maryland, New Jersey, New Mexico, Oklahoma, Pennsylvania and Texas. Novitas also covers the Washington, D.C., metro area.
McKnight’s efforts to reach Novitas for comment were unsuccessful.
Novitas noted in the December disclosure that it re-evaluates transportation rates for portable X-ray suppliers every five years.
“As a Medicare Administrative Contractor (MAC)-priced service, the MAC must initially determine payment for portable X-ray transportation service that is associated with the cost of providing the service,” the company said. “Factors include the cost of the vehicle, vehicle modifications, gasoline and the staff time involved in only transportation for the portable X-ray service.”
The company, which has been seeking cost information from radiology providers since 2018, is asking for additional survey responses by March 31. A final determination on payment for transportation will take place at that time, the company said. A MAC is a private healthcare insurer that oversees a geographic jurisdiction to process Medicare Part A and B medical claims or durable medical equipment claims for Medicare fee-for-service beneficiaries.
Between now and March 31, NASL will provide Novitas data with hopes that it will re-evaluate the rate change, Morton said.
“We sincerely hope they’ll better understand the costs involved and not implement a cost of this magnitude that will have these impacts,” Morton said.