Medicare Adds Payment for Chronic Care Management

By M. Thomas Langan II.

Beginning January 1, 2015, health care providers can submit claims to Medicare for staff time used for developing and implementing a care plan for a patient with at least two chronic conditions. This addition is in response to complaints from providers that they have to spend a lot of time coordinating care with numerous healthcare contacts that the patient has – time that was previously not billable. The applicable code can be submitted once per patient per calendar month. It is recommended that staff members document their time coordinating the care to support the claim.

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CMS Issues Final Rule on Physician Fees for 2013

On November 1, the Center for Medicare & Medicaid Services released a final rule for 2013 on the payments that Medicare will issue for physicians’ fees. Several items in the rule are notable. First, the rule includes a required 26.5 percent reduction to Medicare payments. At this point, it is unclear whether Congress will accept the reduction in light of increased calls for fiscal restraint or whether it will continue to deny the reduction. Assuming that Congress does reject the reduction, payment to primary care practitioners may increase by anywhere from three to seven percent.

The rule also finalizes several changes made to the Meaningful Use and PQRS incentive programs, and will make a series of additional incentives available over the next several years. In addition, it includes new policies allowing for reimbursement for care coordination services provided for up to 30 days following certain kinds of treatment in a hospital or skilled nursing facility. Finally, certified registered nurse anesthetists will now be included in the group of professionals that may be reimbursed by Medicare, to the extent of any service they may provide under state law. These changes are the primary causes of the projected increase in payment to practitioners; however, this increase is contingent on Congress’s action with regard to the final rule.

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30 Day SGR Freeze Extension Passed in Senate

On March 2, 2010, the Senate passed a 30 day extension of the sustainable growth rate (“SGR”) freeze.  The bill will now go to the President for his signature.

The legislation extends the Medicare payment freeze through March 31, 2010, which will temporarily void the 21% reduction in Medicare reimbursements.   

This is only a temporary measure.  Congress will have to pass either another extension or a permanent fix, otherwise the 21% cut will occur on April 1, 2010. 

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On March 1, 2010, the 21 percent overall cut in Medicare reimbursements to physicians became effective.  However, it could still be averted by a month-long stay that the U.S. House passed on February 25, 2010; action is pending in the Senate.

In the meantime, more physician practices are considering not accepting new Medicare patients. Many other physicians are seeking employment at hospitals.  Others are focusing more on patients who pay out of pocket and ending relationships with insurers that cut rates.

If the Senate passes the temporary fix that is expected to put the 21 percent cut on hold, it would be the latest in a series of patches that have become a nearly annual custom in Congress since 2003.

Under the formula by which doctors are paid by Medicare, growth in total payments to physicians cannot exceed annual growth in the nation’s gross domestic product.  As the United States population ages, doctors are serving more patients and using more costly treatments and tests accompanied by advances in technology.  As a result, physicians are requesting reimbursements that exceed GDP growth, which has averaged about 3 percent. Medicare is required to ensure that total payments do not exceed budget.

Lobbyists for physicians, including the American Medical Association, have played the primary role in persuading Congress to keep the rate cuts from going into effect.

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