TUCSON, Ariz., July 16, 2018 /PRNewswire-USNewswire/ -- The
Centers for Medicare and Medicaid Services (CMS) has acknowledged
the tremendous administrative burden physicians bear for
documenting office visits for evaluation and management (E/M),
states the Association of American Physicians and Surgeons
(AAPS).
There are five levels of E/M visits with AMA-copyrighted codes,
each requiring a set of "bullet points" in the record of the visit,
often entered by extensive cutting and pasting from other parts of
the record. "Upcoding" to collect a slightly higher fee is
considered fraud, punishable by draconian fines and
imprisonment.
Under the proposed new rule, which is part of the Patients Over
Paperwork initiative, doctors who like the 1995 or 1997
documentation guidelines could keep them, or they could use medical
decision-making or time as the governing factor in choosing the
visit level. In the current system, time counts only if counseling
or care coordination dominate the visit.
According to a CMS press release, the streamlining is estimated
to save a clinician a full 51 hours per year, if 40 percent of the
practice is Medicare. That would be about one hour per week, 10
minutes a day, or less than 1 minute per patient.
Payment rates under the new rule would be "blended." For level 2
through 5 visits, current fees for an established patient range
from $45 to $148, and for a new patient from $76 to $172. The
new schedule would pay $93 for an
established or $135 for a new
patient, regardless of the complexity of the service. Documentation
need only be sufficient to justify a level 2 visit.
"Specialists who provide many level 4 and 5 visits to
complicated patients would see a large decrease in revenue based on
this blending," noted AAPS executive director Jane M. Orient,
M.D.
CMS states that the proposal is budget neutral—for the
government, considering potential add-ons and other factors
involved in calculating payments under the Resource-Based Relative
Value Scale (RB-RVS), the Medicare price-control system.
The revisions to the physician fee schedule are part of a
1,473-page rule that also includes proposed changes to the Quality
Payment Program with its Merit-based Incentive Payment System
(MIPS), even though the Medicare Payment Advisory Commission
(MedPAC) voted 14 to 2 to junk MIPS.
If physicians invest tens of thousands of dollars in MIPS
participation, they might be able to earn a small bonus, but many
are accepting a "downward adjustment" in fees rather than incur the
costs, Dr. Orient stated.
"The only way to restore the patient-physician relationship is
to opt out of Medicare," she said. "Medicare will then refuse to
cover the physician's fee but might still cover tests and
prescriptions."
The Association of American Physicians and Surgeons (AAPS) is a
national organization representing physicians in all specialties,
founded in 1943.
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SOURCE Association of American Physicians and Surgeons
(AAPS)