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Medicare Reimbursement Change 2019

Home Practice Management Medicare Reimbursement Change 2019

  • Avatar MrsIMDoc 
    Participant
    Status: Physician
    Posts: 230
    Joined: 01/09/2016

    I am in another group that is discussing the 2019 Proposed Changes to Medicare. They are saying reimbursement for 99214 and 99215 will change to 99213 BUT I cannot find documentation of this. This is a big deal if this is true.  Has anyone else heard this or have information? My googling skills for the reimbursement change to 99213 were not successful.

    This is allI could find: https://www.aafp.org/journals/fpm/blogs/gettingpaid/entry/em_coding_proposed_changes.html

    Thoughts?

    #137421 Reply
    Rando Rando 
    Participant
    Status: Physician
    Posts: 204
    Joined: 01/08/2016

    I got the following e-mail a couple days ago from CMS.  It doesn’t say the level of reimbursement but it does say the different levels (99213, 99214, etc) are going away.

     


    A Letter to Doctors from CMS Administrator Seema Verma

    Dear Doctor,

    Thank you for the difference you make in your patients’ lives. Many of our nation’s best and brightest students go into medicine – the competition is intense for every spot. To become a practicing physician, you had to put in years of training, hours of studying, and long days and nights on the wards.

    Your dedication and commitment have enabled you to join the profession that makes up the core of our healthcare system. But after years of education, training, and hard work, our system is not fully leveraging your expertise. Instead, doctors today spend far too much of their time on burdensome and often mindless administrative tasks.

    From reporting on measures that demand that you follow complicated and redundant processes, to documenting lines of text that add no value to a patient’s medical record, to hunting down records and faxes from other physicians and sifting through them, wasteful tasks are draining energy and taking time away from patients. Our system has taken our most brilliant students and put them to work clicking through screens and copying and pasting. We have arrived at the point where today’s physicians are burning out, retiring early, or even second-guessing their decision to go into medicine.

    In a recent Medscape survey of over 15,000 physicians, 42 percent reported burnout.

    Enough is enough. CMS’s focus is on putting patients first, and that means protecting the doctor-patient relationship. We believe that you should be able to focus on delivering care to patients, not sitting in front of at a computer screen.

    Washington is to blame for many of the frustrations with the current system, as policies that have been put forth as solutions either have not worked or have moved us in the opposite direction. Electronic Health Records were supposed to make it easier for you to record notes, and the government spent $30 billion to encourage their uptake. But the inability to exchange records between systems – and the increasing requirements for information that must be documented – has turned this tool into a serious distraction from patient care.

    CMS is committed to turning the tide. President Trump has made it clear that he wants all agencies to cut the red tape, and CMS is no exception. Last year, we launched our “Patients Over Paperwork” initiative, under which we have been working to reduce the burden of unnecessary rules and requirements. As part of this effort, we have proposed an overhaul of the Evaluation & Management (E&M) documentation and coding system to dramatically reduce the amount of time you have to spend inputting unnecessary information into your patients’ records. E&M visits make up 40 percent of all charges for Medicare physician payment, so changes to the documentation requirements for these codes would have wide-reaching impact.

    The current system of codes includes 5 levels for office visits – level 1 is primarily used by nonphysician practitioners, while physicians and other practitioners use levels 2-5. The differences between levels 2-5 can be difficult to discern, as each level has unique documentation requirements that are time-consuming and confusing.

    We’ve proposed to move from a system with separate documentation requirements for each of the 4 levels that physicians use to a system with just one set of requirements, and one payment level each for new and established patients. Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden. If you add up the amount of time saved for clinicians across America in one year from our proposal, it would come to more than 500 years of additional time available for patient care.

    In addition to streamlining documentation, under the leadership of the White House’s Office of American Innovation, we are advancing the MyHealthEData Initiative which promotes the interoperability of electronic medical records. Patients must have control of their medical information; and physicians need visibility into a patient’s complete medical record. Having all of a patient’s information available to inform clinical decision-making saves time, improves quality, and reduces unnecessary and duplicative tests and procedures. CMS is taking action to make this vision a reality, including recently proposing a redesign of the incentives in the Merit-Based Incentive Payment System or “MIPS” to focus on rewarding the sharing of healthcare data securely with patients and their providers.

    We welcome your thoughts on our proposals, and we look forward to partnering with you

    to make them successful. Patients and their families put their trust in your hands, and you should be able to focus on keeping them healthy. And to secure the future strength of our system, we must make sure that the nation’s best students continue to choose to go into medicine.

    We need your input to improve the healthcare system. Once again, thank you for your

    service to your patients.

    Sincerely,

    Seema Verma

    #137423 Reply
    Avatar HikingDO 
    Participant
    Status: Physician
    Posts: 369
    Joined: 03/09/2017

    So it looks like I’ll be getting the same reimbursement for an uncontrolled DM with multiple med refills, labs to review, and referrals to order as I will for a URI. This doesn’t “cut red tape” or save me time, it just pays me less. So glad I’m getting closer to FIRE.

    #137439 Reply
    Liked by Anne, Vagabond MD
    Rando Rando 
    Participant
    Status: Physician
    Posts: 204
    Joined: 01/08/2016

    So it looks like I’ll be getting the same reimbursement for an uncontrolled DM with multiple med refills, labs to review, and referrals to order as I will for a URI. This doesn’t “cut red tape” or save me time, it just pays me less. So glad I’m getting closer to FIRE.

    Click to expand…

    I will probably be retired when/if this goes into effect, but if I’m not I would figure out a way to focus on volume as that is what will get rewarded.

    #137445 Reply
    Liked by HikingDO
    Avatar MEtoNC 
    Participant
    Status: Spouse
    Posts: 25
    Joined: 06/05/2017

    So it looks like I’ll be getting the same reimbursement for an uncontrolled DM with multiple med refills, labs to review, and referrals to order as I will for a URI. This doesn’t “cut red tape” or save me time, it just pays me less. So glad I’m getting closer to FIRE.

    Click to expand…

    Yep, they propose that a level 2 to 5 gets paid 1.22 RVU’s.

    #137446 Reply
    Liked by HikingDO
    Avatar HikingDO 
    Participant
    Status: Physician
    Posts: 369
    Joined: 03/09/2017

    So it looks like I’ll be getting the same reimbursement for an uncontrolled DM with multiple med refills, labs to review, and referrals to order as I will for a URI. This doesn’t “cut red tape” or save me time, it just pays me less. So glad I’m getting closer to FIRE.

    Click to expand…

    I will probably be retired when/if this goes into effect, but if I’m not I would figure out a way to focus on volume as that is what will get rewarded.

    Click to expand…

    Exactly. You have a complicated time consuming uncontrolled DM? Refer to endocrine. An older patient with several med issues? Instead of managing him yourself, refer to nephology, GI, pulmonology, and cardiology. A healthy patient with a cough for 6 hours? Hey, come in on, I’ll be happy to see you right now! Not sure who in Medicare thought that this would work, it’s idiotic.

    #137454 Reply
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3567
    Joined: 01/14/2017
    Splash Refinancing Bonus

    Ok, this looks bad.  Take a look at page 331 on, specifically tables 19 and 20 on page 350:

    https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf

    #137458 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1233
    Joined: 11/07/2017

    Wow.  That letter reads like the governmental version of a “it’s not you, it’s me” break up speech just before they tell you they’ve been cheating on you with your best friend and stole all your stuff.  “But you’re a really great person and I hope we can be friends!”

    How many more doctors are going to drop Medicare with this change?  It makes me nervous for those counting on working until Medicare age for the healthcare coverage.

    #137472 Reply
    Avatar HikingDO 
    Participant
    Status: Physician
    Posts: 369
    Joined: 03/09/2017

    Well, if I have to look at the positive side, at least I won’t need to worry about coding!

    S: Here to review labs, no complaints

    O: exam normal

    A: DM

    P: change meds as listed below, f/u in 3 months

    Walah, my new DM 99214 note!

    #137475 Reply
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3567
    Joined: 01/14/2017

    Wow.  That letter reads like the governmental version of a “it’s not you, it’s me” break up speech just before they tell you they’ve been cheating on you with your best friend and stole all your stuff.  “But you’re a really great person and I hope we can be friends!”

    How many more doctors are going to drop Medicare with this change?  It makes me nervous for those counting on working until Medicare age for the healthcare coverage.

    Click to expand…

    I’d also worry about private payers following suit.  This is a 36% reduction in payment for a level 5 visit and 19% reduction for level 4 visit.  If you see more complex patients as part of your practice and/or spend more time with them you stand to see significant reductions in any payment associated w/ RVU based incentives.  Even strictly salaried people will see the hit in later contracts as hospitals realize they aren’t taking in as much and offer either less in benefits or less in salary as part of the new contract.  Trouble is, there won’t be some fantastic alternative to run to so you’ll be stuck.  All this does is hurt providers, particularly physicians, and more specifically those putting in the time seeing more complex patients.  And this is going to result in better care for our elderly and more complex patients how?  This provides the incentive to spend less time with them.  19-36% less time, to be exact.

    #137477 Reply
    Avatar HikingDO 
    Participant
    Status: Physician
    Posts: 369
    Joined: 03/09/2017

    Ok, this looks bad.  Take a look at page 331 on, specifically tables 19 and 20 on page 350:

    https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf

    Click to expand…

    Looking at page 367, it’s a bad day to be an endocrinologist….

    #137485 Reply
    Liked by nfldoc
    portlandia portlandia 
    Participant
    Status: Physician
    Posts: 414
    Joined: 07/07/2017

    The letter states “Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy”

    What data are they looking at to come to this conclusion?

    Update: looking through the link https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf I am seeing it now.

    #137488 Reply
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3567
    Joined: 01/14/2017

    Ok, this looks bad.  Take a look at page 331 on, specifically tables 19 and 20 on page 350:

    https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf

    Click to expand…

    Looking at page 367, it’s a bad day to be an endocrinologist….

    Click to expand…

    That’s terrible.  What worse is that things are more nuanced than that.  Take ENT, for example.  They think we’re going to see a bump by 5%.  First of all, I don’t trust any government projections, and why should anyone – they’re always inaccurate to the downside.  Secondly, and this is my main point, is that we have become subspecialized where we now (thankfully) have H&N oncologic surgeons who see complex and sick patients and do complex work.  We need them doing that.  But they typically code level 4/5 visits, as they should, for new patients.  They are going to see a 19-35% reduction in their payments, whereas the generalist who does bread/butter ear tubes/tonsils where they may have been billing level 2/3 visits are going to get paid more.  So it’s going to vary a lot, and it’s going to hurt those who have specialized and/or have committed to spend more time with more complex patients.  In the words of Donald Trump, SAD!

    #137490 Reply
    Rando Rando 
    Participant
    Status: Physician
    Posts: 204
    Joined: 01/08/2016

    Much of FP office medicine is deciding between 99213 and 99214, and obviously charging as many 99214’s legitimately as you can.  I think the chart is right that this won’t have much effect on FP, and less documentation could even be beneficial either by increasing patient volume or getting home earlier.

     

    I think I read somewhere that 11% of physicians code level 5’s on ALL visits (there was a doc in my town that did), and this change would obviously put an end to that.

    #137499 Reply
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3567
    Joined: 01/14/2017

    Much of FP office medicine is deciding between 99213 and 99214, and obviously charging as many 99214’s legitimately as you can.  I think the chart is right that this won’t have much effect on FP, and less documentation could even be beneficial either by increasing patient volume or getting home earlier.

     

    I think I read somewhere that 11% of physicians code level 5’s on ALL visits (there was a doc in my town that did), and this change would obviously put an end to that.

    Click to expand…

    In other news, 11% of physicians got audited in 2017.  🙂

    #137502 Reply

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