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Medicare Cuts Medical Consultation Codes
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The AMA REPORTS HERE that "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 Jan. 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."

The CMS predicted that "no specialty would see Medicare revenues decline by more than 3% because of the change. CMS also had stated that another goal was to reduce confusion and administrative burdens associated with filing consultation codes."

But the policy has had the opposite effect, according to a survey "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."

"Another unintended consequence involves prolonged services for hospitalized patients. The current procedural terminology system on which Medicare codes are based count both face-to-face time with the patient and time spent on the hospital floor. But CMS now recognizes only face-to-face time and not other services, such as reviewing charts, or talking with families and other medical staff."

"In effect, Medicare is denying payment for these services and further discouraging coordination of care between professionals," the AMA states.

"The American Academy of Neurology estimates that nearly 75% of its members responding to the AMA survey have seen revenues fall by more than 10% since January, and nearly 40% have had to reduce staff."

"The American College of Cardiology noted that the patients who need the most help will feel the effects the most."

The American College of Rheumatology estimates that the elimination of the codes has negatively affected 80% of practicing rheumatologists who responded.."

"Many of the 5,500 physician respondents to a recent survey...said the...policy change has cut into their revenue and caused them to pursue or consider cutbacks of their own."  Some 35% said that their revenue stream had been reduced less than 10%;  40% had between a 10 and 20% reduction in revenue;  12% had more than a 20% reduction.


 
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