Final Medicare Fee Schedule Rewards Primary Care Pay, Surgeon Coding

The Center for Medicare and Medicaid Services (CMS) has released a final version of its Medicare fee schedule for 2017 that makes good on earlier proposals to pay primary care physicians more for work that was previously uncompensated or undercompensated.

Surgeons also received some good news, or less bad news — depending on one’s perspective — in the fee schedule. CMS is going ahead with its announced plan to have surgeons code their postoperative work during a global billing period, but significantly relaxing the requirements, which surgical societies called too burdensome.

On the primary care side, Medicare will begin to pay more in 2017 for treating patients with chronic illnesses and those with cognitive and behavioral problems. The new fee schedule includes billing codes for:

• Comprehensive assessment and care-planning for patients with cognitive impairments such as dementia
• Chronic-care management that goes beyond routine chores such as talking to patients on the phone about medication issues
• Collaboration with mental health specialists to treat patients with behavioral problems
• Prolonged evaluation and management services that occur outside of a patient visit

CMS Acting Administrator Andy Slavitt wrote today in a blog entry on the agency’s website that these changes could put an estimated $140 million in extra reimbursement in the pockets of primary care clinicians next year.

Like what you’re reading? Follow us for the latest Healthcare Industry News! 

“Over time, if the clinicians qualified to provide these services were to fully provide these services to all eligible beneficiaries, the increase could be as much as $4 billion or more in additional support for care coordination and patient-centered care,” Slavitt said.

In another boon to primary care, the final version of the 2017 fee schedule will expand a pilot project for preventing diabetes in 2018. Under the Medicare Diabetes Prevention Program, patients at high risk for developing type 2 diabetes can go to a community-based program that promotes exercise, a better diet, and weight loss. Besides preventing diabetes, Medicare hopes to save several thousand dollars a year per beneficiary in healthcare costs.

Escape From a Coding “Nightmare”

Surgeons, meanwhile, have escaped what some called a coding “nightmare.”

In the proposed fee schedule, CMS sketched out a plan to have surgeons use eight new “G” billing codes to track their work in 10-minute increments during global surgical “packages.” Spanning either 10 days or 90 days, these global packages encompass preoperative and postoperative care in addition to the procedure itself.

Medicare pays a lump sum for some 4200 global packages, but the program has worried that it’s overpaying for them, especially when it comes to postoperative office visits. The agency cites studies showing that the actual number of postoperative visits frequently falls short of the number assumed for the global package — six visits, say, as opposed to the projected 10.

The Medicare Access and CHIP Reauthorization Act blocked an attempt by CMS to phase out global packages of 10 days and 90 days, but directed the agency to begin collecting data from a representative sample of physicians about preoperative and postoperative services no later than 2017. The proposed 2017 fee schedule incorporated that directive. What galled medical societies such as the American College of Surgeons, however, was the fee schedule’s sweeping requirement for all surgeons to code their postoperative work in 10-minute increments with the new G codes. Organized medicine blasted the plan as distracting surgeons from patient care and costing them up to $100,000 in terms of compliance.

CMS relented in the face of these protests. The final version of next year’s fee schedule has reduced reporting chores for surgeons (and primary care physicians who perform globally billed procedures) by:

• Limiting the reporting of postoperative visits to high-volume/high-cost procedures.
• Designating an existing bill code (99024) to track each postoperative visit during a global package in place of multiple G codes. The 99024 code dispenses with time-keeping.
• Requiring only surgeons in practices of 10 or more clinicians in selected states to report postoperative visits.
• Allowing all other clinicians to report voluntarily.

CMS also has pushed back the start date for required reporting from January 1, 2017, to July 1, 2017. Procedures performed in the first 6 months of 2017, therefore, will be exempt.