On the Elimination of Medicare Consultation Codes

Is it Budget Neutral?

By Brian J. Knabe MD, CFP, CMP

http://www.CertifiedMedicalPlanner.org

The New Year 2010 has brought some changes in the Medicare Physicians Fee Schedule.  For many specialists, the most significant change is the elimination of consultation codes, 99241-99245 in the outpatient setting and 99251-99255 for inpatient care.  Physicians can still provide consultations and bill for these services – using codes for routine new or established patient visits (99201-99205 and 99211-99215).

Reported Revenue Neutrality

It has been reported that this change has been made in a revenue neutral manner.  Reimbursement for all E/M codes has been increased in order to make up for the removal of consultation codes.  The increase is approximately 6% in the outpatient setting and about 2% for inpatient codes.

Of Averages and Outliers 

The result of these changes might be revenue neutral overall, but the outlier effect on many specialties and individual physicians can be significant.  Specialists who obtain most of their income from procedures will see less of an effect on their income.  This includes dermatologists, surgeons, and gastroenterologists.  Less procedurally-oriented specialists, particularly those who rely upon Medicare as a primary payor, are seeing the most significant effect.  For example, neurologists and hematologists will likely see double-digit declines in revenue.

Private Payers 

While private payers have not yet adopted these changes, billing codes must be adjusted when filing a claim with a commercial insurer when Medicare is the secondary insurer.  If a consultation code is used in these instances, the primary payer will pay their portion of the bill, but Medicare will deny secondary coverage.  There is no indication yet that commercial insurers are dropping the consultation codes altogether, but if history is any indication, they will likely eventually follow the lead of Medicare.

Join Our Mailing List

Assessment 

Physicians can take certain measures to decrease the impact of these changes on their revenue stream.  It is increasingly important to understand how the complexity of a patient visit affects the appropriate level to be billed.  Prolonged service codes are also available (99356 and 99357) to enable physicians to bill appropriately for more complex and time-consuming evaluations.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

Dr. Atul Gawande’s “Checklist Manifesto” and Book Review

Healthcare Reform’s Rock Star -or- Much Needed Plain Speaker?

By Hope Rachel Hetico; RN, MHA, CMP™

[Managing Editor]

Here is an essay-interview by Rahul K. Parikh MD, with Atul Gawande MD, as they talk about medicine, checklists and quality healthcare.

Book Review

In Gawande’s third book, “The Checklist Manifesto: How to Get Things Right,” he explores how doctors and other professionals become overwhelmed with the complexity of their work. And, are then more likely to fail.

As with most problems that sound overwhelmingly complex, the fix may be quite easy, when reframed with a new mindset and fresh set of young eyes.

Assessment

Gawande’s proposed solution is simple and inexpensive, if not terribly sexy: a checklist. Sound too mundane? Keep in mind that Gawande has previously proved, in conjunction with the World Health Organization [WHO], that doctors and surgical teams who use checklists save lives.

Link: http://www.salon.com/books/int/2010/02/02/atul_gawande_checklist/index.html

Conclusion

And so, your thoughts and comments on this ME-P are appreciated.

Is Atul this generation’s healthcare quality guru, much like Robert Wachter MD. Or, is he a man-child not afraid to say that the Emperor has no clothes? Please opine.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

%d bloggers like this: