Menu

Medicare Reimbursement Change 2019

Home Practice Management Medicare Reimbursement Change 2019

  • Avatar stellardoc1 
    Participant
    Status: Physician
    Posts: 56
    Joined: 07/21/2016
    Splash Refinancing Bonus

    Pages 369 and 370 propose that there will be modifiers for complex patients.

    This actually may be a good thing after all. Simplify the notes, add modifier for complex patients and move on.

    If at the end of the day, there is not much impact on the revenue, I would welcome this approach as it would significantly decrease the documentation burden.

     

    #137508 Reply
    Liked by Rando
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 2598
    Joined: 05/01/2017

    Taking away these crazy rules about documentation would be a massive wellness boost for docs.

    Esp in a field like EM why can we not be paid out based on ED dx with a modifier as needed?

     

    #137510 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 3041
    Joined: 01/03/2017

    It’s the government. What could go wrong?

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #137514 Reply
    childay childay 
    Participant
    Status: Physician
    Posts: 1072
    Joined: 01/09/2016

    Sounds like a cost-containment strategy masquerading in a we care about doctors disguise..

    At the bottom I see they propose adding 21 “quality” measures for psychiatry and only propose removing one..

    #137519 Reply
    Avatar HikingDO 
    Participant
    Status: Physician
    Posts: 369
    Joined: 03/09/2017

    Sounds like a cost-containment strategy masquerading in a we care about doctors disguise..

    At the bottom I see they propose adding 21 “quality” measures for psychiatry and only propose removing one..

    Click to expand…

    Pretty much what I thought. Seems to be the theme nowadays….

    #137522 Reply
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6327
    Joined: 01/12/2016

    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…

    Lol. That letter is awesome. “you complained about burdensome paperwork, so we reduced it along with your pay…you’re welcome”.

    Avatar LizOB 
    Participant
    Status: Physician
    Posts: 322
    Joined: 06/05/2017

    The incentive will be to deal with as few problems as possible per visit and have the pt make multiple visits.

    You want to discuss contraception AND your abnormal discharge? Pick one today, we’ll do the other next time. Twice the pay compared to dealing with both issues on the same day, if I’m understanding this correctly.

    #137536 Reply
    wonka31 wonka31 
    Participant
    Status: Physician
    Posts: 714
    Joined: 03/24/2018

    You may do that (and should), but many wil not. Thy are banking on the ‘many’. Simply put, this plan is shortsighted and may have some significant unintended consequences. Many intelligent people on this thread have already pointed out some of these potential consequences.

    #137572 Reply
    Avatar ticker 
    Participant
    Status: Physician
    Posts: 168
    Joined: 08/14/2016

    I would be negatively affected by this, but I really fear for the academic centers where super-specialists are disproportionately represented.  I refer to some who see only 12 or 14 patients a day (currently all appropriately level 4 and 5 visits).  They are already having trouble making money.  A 25+% cut in reimbursement would be really hard on them.

    #137587 Reply
    Liked by Firefly
    Avatar Wings3496 
    Participant
    Status: Physician
    Posts: 28
    Joined: 11/05/2016

    Primary care here – most of our visits are complex patients with multiple problems being billed at -214, occasional -215’s. A small sprinkling of -213’s. I fear this change would hit us dramatically. I read in another forum that the “complexity” or primary care modifier they suggested adding might add as little as $3 to the visit reimbursement.

    Really hope this doesn’t go through – I’m just starting my career and trying to aggressively pay off loans, this isn’t the time for physician salaries to take a bit hit!

    #137592 Reply
    Avatar MrsIMDoc 
    Participant
    Status: Physician
    Posts: 230
    Joined: 01/09/2016

    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.

    Click to expand…

    I charge level 5 for about 50% and level 4 for about 50%. I do geriatrics and spend minimum of 30 min per patient. I keep patients out of the hospital. This will kill that.

    #137599 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    Sounds like more testing and procedures, less time talking to patients.

    #137600 Reply
    childay childay 
    Participant
    Status: Physician
    Posts: 1072
    Joined: 01/09/2016

    Sounds like more testing and procedures, less time talking to patients.

    Click to expand…

    Thats the way to save money CMS!  Nailed it!

    #137604 Reply
    Liked by LizOB
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 199
    Joined: 01/02/2018

    Also seems to increase the value of midlevels (or at least anyone who deals with the most straightforward patient complaints) relative to doctors.

    #137609 Reply
    Liked by Zaphod, pulmdoc, nfldoc
    Avatar Echo 
    Participant
    Status: Physician
    Posts: 57
    Joined: 03/09/2016

    Below is some information I received from my specialty society:

    “Among the various proposals aimed at streamlining E/M reporting, CMS seeks to create a single payment of $93 for established patient codes 99212-99215 that would replace distinct pay rates for each of the four codes. That rate, in 2018 dollars, is roughly smack in the middle of payments for 99213 ($74) and 99214 ($109). The rate is significantly lower than level 5 code 99215, which pays $148 this year.

    • CMS proposes add-on G codes for primary care. CMS proposes a primary care-specific G code that providers could attach to E/M encounters and that would “more accurately account for the type and intensity of E/M work performed in primary care-focused visits,” the rule states.

    The agency expects that the code would get widespread use. “As this add-on G-code would account for the inherent resource costs associated with furnishing primary care E/M services, we anticipate that it would be billed with every primary care-focused E/M visit for an established patient,” CMS states. Currently, proposed payment rates are unclear.

    As proposed, the dummy code reads as follows: GPC1X (Visit complexity inherent to E/M associated with primary medical care services that serve as the continuing focal point for all needed health care services [Add-on code, list separately in addition to an established patient evaluation and management visit]). The code would be assigned 0.07 work RVUs. “This proposed valuation accounts for the additional work resource costs associated with furnishing primary care that distinguishes E/M primary care visits from other types of E/M visits and maintains work budget neutrality across the office/outpatient E/M code set,” CMS says.

    • Specialists get a G code, too. CMS doesn’t intend to leave specialists out when it comes to add-on G codes for E/M encounters. Designed for “specialty professionals for whom E/M visit codes make up a large percentage of their overall allowed charges,” CMS created the following add-on:GCG0X (Visit complexity inherent to evaluation and management associated with endocrinology, rheumatology, hematology/oncology, urology, neurology, obstetrics/gynecology, allergy/immunology, otolaryngology, cardiology, or interventional pain management-centered care [Add-on code, list separately in addition to an established patient evaluation and management visit]). CMS would assign 0.25 work RVUs to the code.”

    I read this to say that in cardiology, all my E/M office visits will now be paid as halfway between current level 3 and level 4 visits, PLUS the extra G code of 0.25 wRVU.  Primary care will be the same, but their extra G code is only work 0.07 wRVU.  How this affects you as an individual depends on your current mix of billing Level 2-Level 5.

    #137718 Reply

Reply To: Medicare Reimbursement Change 2019

In case of a glitch or error, please save your text elsewhere, clear browser cache, close browser, open browser and refresh the page.

Notifications Mark all as read  |  Clear