We've implemented a new policy for Medicare Low-Volume Adjustments (LVA)

To ensure low-volume hospitals are paid fairly and accurately at the end of each year for their Medicare claims, we’ve put a new policy in place at Priority Health.

Resetting our LVA each October

Each year, the Centers for Medicare and Medicaid Services (CMS) updates its LVA rates. There’s a 2+ month delay between the time when this year’s LVA rate expires and CMS sends us next year’s LVA rates.

During that delay, from Oct. 1 to January of the following year, CMS’s LVA rate is set to zero. This results in claim underpayments for the duration of the delay followed by claim reprocessing.

To support our low-volume hospitals, we’ll reset our LVA each October, keeping the current value in place until we receive the new rate from CMS.

Once we have the new LVA rate from CMS, we update our systems within 30 days.

Do you have an LVA letter?

If you send us a copy of the LVA letter you receive from CMS showing your new LVA rate before we receive our files from CMS, we’ll make the appropriate updates following our standard 30-day timeline.

Learn more about low-volume adjustments from CMS.