AOPA Submits Comments Regarding Improving the Medicare Gap Filling Process
On September 10, 2018, AOPA submitted formal comments to CMS regarding suggestions on how to improve the “gap filling” process that is currently used to establish Medicare fee schedule amount for new HCPCS codes. The opportunity to provide comments was the result of the annual proposed rule regarding Medicare coverage of End Stage Renal Disease (ESRD) and DMEPOS competitive bidding. The proposed rule requested suggestions from interested parties on how to improve the gap filling process.
Gap filling is used to establish Medicare fee schedules for new HCPCS codes. Current statutory requirements mandate that when a new code is issued, CMS establishes a base price for the device, deflates the price to 1986-1987 rates by applying the annual consumer pricing index for urban areas (CPI-U) and then re-inflates it by applying the annual update to the Medicare O&P fee schedule. Since the O&P update has not always equaled the CPI-U, gap filling results in a slightly lower price than the base price that was established for the device.
The gap filling process has never been transparent and represents an archaic and outdated process that does not consider important factors such as professional service and clinical expertise when calculating Medicare fee schedules. AOPA welcomed the opportunity to provide comments and made several suggestions it believes will greatly improve the current system.