Cross Walking

Written by Norene Anderson
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Cross walking is the method of determining a reimbursement fee for a new procedure or test. It is the process of taking an existing procedure or item that is similar technically or clinically to the new one and giving it the related reimbursement fee amount. This process is favored by some and opposed by others. The opposition comes from those who say the existing fee schedule is too outdated to reflect current costs. Many of the fees have not been changed since the 1980s.

The alternative to cross walking for new products is "gap filling." This takes on a different slant to pricing. If there are no codes that are similar to the new procedure or product, the price is set by each local Medicare carrier. After the price has been in existence for one year, the CMS takes all of the local prices and comes up with a national average for the pay rate. If a carrier is above the limit, they must lower the payment. If they are below the limit, they are not required to raise the payment.

The Cross Walking or Gap Filling Choice

This controversy about the choice of cross walking or gap filling is ongoing between the vendor organizations and the specialty societies. Some like the cross walking because of its predictability. Others like the gap filling for the opportunity to set new rates. Sometimes a product or procedure is cross-walked with an existing code that actually increases the fee schedule.

The processes in the works today are far ahead of the technology and options available when the system originated. There are many calling for a system upgrade of the fee schedules to be competitive in today's healthcare environment. There is great concern that without this change, advancements will be compromised due to inadequate reimbursement.


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