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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.
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
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Filed under: Health Insurance, Health Law & Policy, Practice Management | Tagged: brian knabe, CPT codes, EM codes, medical billing codes, medicare, physician fee schedules |
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Physicians Against Medicare Cuts
A poll of nearly 1,500 physicians found 84 percent saying they will be forced to cut back the number of patients admitted, if the Medicare cuts scheduled to take effect April 1, 2010 hold. Some physicians participating in the poll said they may even have to close their practices altogether.
http://www.healthcarefinancenews.com/news/poll-physicians-arms-against-medicare-cuts
Polling results are available from Sermo.
Gene
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Gene and Dr. Knabe
The Centers for Medicare & Medicaid Services do not currently pay for virtual colonoscopies and thereby limit access to a screening test that advocates say is as accurate as a standard colonoscopy and much less invasive for the patient. However, many private health insurers, including Cigna, UnitedHealthcare, and Anthem BlueCross and BlueShield now cover CT colonography for their beneficiaries.
I wonder what the reimbursement policy would look like under Obama Care? Incidentally, the President had a virtual, not real, colonoscopy during his last physical examination.
Call me … Dr. Guts
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As I understand the rumors about the 2,700 pages of an even more expensive plan to save money starting a decade from now, it appears that a significant portion of the estimated billions in savings through healthcare reform is dependent on a not-necessarily bipartisan commitment to pay physicians less than they earn today. What a plan!
If the Government Accounting Office allows this stinker to slip quietly around the grave of Adam Smith, then I have a real crowd-pleaser. Why wait 20 years to reduce the taxes for our grandchildren? I suggest we commit to paying government officials 30% less starting now!
D. Kellus Pruitt; DDS
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Nixed Medicare Consultation Codes Force Doctors to Make Cutbacks
Thousands of physicians say they have been forced to adopt a number of damaging cost-cutting measures as a result of Medicare discontinuing its use of consultation codes, a policy adopted by the Centers for Medicare & Medicaid Services that took effect on January 1.
Consultation codes are used most frequently by specialists after patients are referred to them by primary care physicians. Starting this year, Medicare eliminated the use of all consultation codes except telemedicine consults. It directed physicians instead to bill for the visits using only evaluation and management codes that apply.
According to a survey of approximately 5,500 physicians, the vast majority of specialists have seen their revenue stream drop after the change — most by more than 5% — and three out of every 10 already have reduced services to Medicare patients or are contemplating other cost cutting steps that will impact care.
Source: Chris Silva, AMNews [8/2/10]
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Dr. Knabe,
Here is a related link:
http://www.physiciansmoneydigest.net/your-practice/Practice-Revenue-Is-Down-Sharply-After-CMS-Killed-Consultation-Codes
Jane
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