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e-Reports, January 11, 2010
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Medicare pay cut halted – for a time

A defense bill approved by both the U.S. Senate and the House and signed by President Obama puts off the Medicare physician reimbursement cut for two months.

The action was included in a Defense Department appropriations bill, which also contained language extending COBRA insurance subsidies for unemployed workers.

The physician rate cut of 21.2 percent was set to start Jan. 1. It has now been delayed through February 2010, giving Congress time to pass a permanent fix that will replace the sustainable growth rate (SGR) formula as the basis for physician Medicare pay.

The AMA, along with 50 state medical societies and 68 national physician organizations, had sent a letter to the House and Senate Dec. 15 urging establishment of a pathway toward permanent repeal of the SGR formula.

The ISMA was a signatory to the letter, which expressed medicine’s firm opposition to passage of a one- or two-year fix to the imminent 21.2 percent Medicare pay cut.

However, the letter acknowledged that the press of current business could prevent Congress from passing legislation to repeal the SGR before the holiday recess.

Out of concern for patient access to care, the groups agreed to support an interim solution, a short postponement of the 2010 pay cut to give Congress more time to pass a permanent solution to the SGR problem.

Read the letter here.

New Medicare consultations billing policy now in effect

On Dec. 23, the AMA advised that the General Counsel for the Department of Health and Human Services said that the Centers for Medicare & Medicaid Services (CMS) could not delay a single section of the final Medicare Physician Fee Schedule Rule (MPFS). Rather, CMS had to either delay or move forward with implementation of the entire rule.

Therefore, CMS implemented Jan. 1 the entire MPFS rule, including the new consultations billing policy.

The AMA had strongly urged a one-year delay in implementation of the new consultations billing policy. Now, the AMA has requested that CMS clarify some of those policies and take additional educational steps to assist physicians.

Find a Med Learn article on this topic here.

Correction: Note these consultation codes ineffective on Jan. 1

The Medicare/Medicaid Coalition Report of Dec. 21 gave incorrect Medicare consultation code information. The ISMA apologizes for any confusion this error caused.

Beginning Jan. 1, the following codes are no longer being reimbursed:

Consultation

  • Outpatient consultation – 99241 through 99245
  • Inpatient consultation – 99251 through 99255

Beginning Jan. 1, use the following evaluation and management codes:

Outpatient

  • New patient – 99201 through 99205
  • Established patient – 99211 through 99215

Inpatient services

  • Initial (admit) visit – 99221 through 99223
  • Subsequent visit – 99231 through 99233

Nursing facility visits

  • Initial visit – 99304 through 99306
  • Subsequent visit – 99307 through 99310
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