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1.
J Cardiovasc Comput Tomogr ; 14(3): 211-213, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31932261

RESUMO

The proposed 2020 CMS Physician Fee Schedule (MFPS) and Hospital Outpatient Prospective Payment System (OPPS) rules issued a reduction in the technical component (TC) payment that would decrease reimbursement for cardiac CT codes by nearly 29% compared to the 2018 final rule. Cardiac CT codes are currently allocated to ambulatory payment classification (APC) 5571, which is used for level I imaging tests with contrast. However, cardiac CT exams utilize more resources and are very different in clinical scope. Current CMS methodology markedly underestimates the actual cost of performing cardiac CT exams. The low reimbursement is a key factor in slowing the adoption of cardiac CT into clinical practice. Grassroot efforts are needed at all institutions who perform cardiac CT, and at local and national levels, to "right-size" reimbursement for cardiac CT exams. This article will provide an overview of various factors affecting cardiac CT reimbursements and advocacy effort.


Assuntos
Assistência Ambulatorial/economia , Centers for Medicare and Medicaid Services, U.S./economia , Tabela de Remuneração de Serviços/economia , Cardiopatias/diagnóstico por imagem , Cardiopatias/economia , Sistema de Pagamento Prospectivo/economia , Tomografia Computadorizada por Raios X/economia , Alocação de Custos , Preços Hospitalares , Custos Hospitalares , Humanos , Valor Preditivo dos Testes , Estados Unidos
10.
Cutis ; 103(4): 208-211, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31116817

RESUMO

With the implementation of the new Medicare Physician Fee Schedule on January 1, 2019, it can be beneficial for all practitioners to grasp an understanding of how reimbursement is determined. With the new Physician Fee Schedule also came new relative value units (RVUs) and new billing codes. Biopsy codes, in particular, were changed to reflect the complexity of the sampling technique (ie, tangential, punch, incisional). In this article, we explain RVUs and how they determine reimbursement. This article also highlights changes and additions to billing codes, specifically for biopsies and telemedicine services.


Assuntos
Current Procedural Terminology , Dermatologia , Grupos Diagnósticos Relacionados , Tabela de Remuneração de Serviços , Humanos , Estados Unidos
11.
N Engl J Med ; 380(16): 1546-1554, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-30995374

RESUMO

BACKGROUND: The Relative Value Scale Update Committee (RUC) of the American Medical Association plays a central role in determining physician reimbursement. The RUC's role and performance have been criticized but subjected to little empirical evaluation. METHODS: We analyzed the accuracy of valuations of 293 common surgical procedures from 2005 through 2015. We compared the RUC's estimates of procedure time with "benchmark" times for the same procedures derived from the clinical registry maintained by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). We characterized inaccuracies, quantified their effect on physician revenue, and examined whether re-review corrected them. RESULTS: At the time of 108 RUC reviews, the mean absolute discrepancy between RUC time estimates and benchmark times was 18.5 minutes, or 19.8% of the RUC time. However, RUC time estimates were neither systematically shorter nor longer than benchmark times overall (ß, 0.97; 95% confidence interval, 0.94 to 1.01; P = 0.10). Our analyses suggest that whereas orthopedic surgeons and urologists received higher payments than they would have if benchmark times had been used ($160 million and $40 million more, respectively, in Medicare reimbursement in 2011 through 2015), cardiothoracic surgeons, neurosurgeons, and vascular surgeons received lower payments ($130 million, $60 million, and $30 million less, respectively). The accuracy of RUC time estimates improved in 47% of RUC revaluations, worsened in 27%, and was unchanged in 25%. (Percentages do not sum to 100 because of rounding.). CONCLUSIONS: In this analysis of frequently conducted operations, we found substantial absolute discrepancies between intraoperative times as estimated by the RUC and the times recorded for the same procedures in a surgical registry, but the RUC did not systematically overestimate or underestimate times. (Funded by the National Institutes of Health.).


Assuntos
Medicare , Duração da Cirurgia , Escalas de Valor Relativo , Procedimentos Cirúrgicos Operatórios/economia , Comitês Consultivos , American Medical Association , Tabela de Remuneração de Serviços , Humanos , Sistema de Registros , Mecanismo de Reembolso , Estados Unidos
12.
Int J Radiat Oncol Biol Phys ; 104(3): 488-493, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30944071

RESUMO

PURPOSE: Interstate variations in Medicaid reimbursements can be significant, and patients who live in states with low Medicaid reimbursements tend to have worse access to care. This analysis describes the extent of variations in Medicaid reimbursements for radiation oncology services across the United States. METHODS AND MATERIALS: The Current Procedural Terminology codes billed for a course of whole breast radiation were identified for this study. Publicly available fee schedules were queried for all 50 states and Washington, DC, to determine the reimbursement for each service and the total reimbursement for the entire episode of care. The degree of interstate payment variation was quantified by computing the range, mean, standard deviation, and coefficient of variation. The cost of care for the entire episode of treatment was compared to the publicly available Kaiser Family Foundation (KFF) Medicaid-to-Medicare fee index to determine if the pattern of payment variation in medical services generally is predictive of the variation seen in radiation oncology specifically. RESULTS: Data were available for 48 states and Washington, DC. The total episode reimbursement (excluding image guidance for respiratory tracking) varied from $2945 to $15,218 (mean, $7233; standard deviation, $2248 or 31%). The correlation coefficient of the KFF index to the calculated entire episode of care for each state was 0.55. CONCLUSIONS: There is considerable variability in coverage and payments rates for radiation oncology services under Medicaid, and these variations track modestly with broader medical fees based on the KFF index. These variations may have implications for access to radiation oncology services that warrant further study.


Assuntos
Tabela de Remuneração de Serviços/economia , Medicaid/economia , Radioterapia (Especialidade)/economia , Mecanismo de Reembolso/economia , Neoplasias Unilaterais da Mama/economia , Codificação Clínica/economia , Cuidado Periódico , Feminino , Sistemas Pré-Pagos de Saúde/economia , Humanos , Movimentos dos Órgãos , Hipofracionamento da Dose de Radiação , Radioterapia Guiada por Imagem/economia , Mecanismo de Reembolso/normas , Respiração , Neoplasias Unilaterais da Mama/radioterapia , Estados Unidos
13.
Health Soc Care Community ; 27(4): 899-906, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30565785

RESUMO

As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January-February, February-March, March-April, and April-May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March-April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.


Assuntos
Tabela de Remuneração de Serviços , Acesso aos Serviços de Saúde/economia , Visita Domiciliar , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Feminino , Humanos , Revisão da Utilização de Seguros , Cobertura do Seguro , Seguro Saúde , Masculino , Médicos , Estudos Retrospectivos , Tóquio
14.
J Am Geriatr Soc ; 67(1): 145-150, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285285

RESUMO

In July 2018, the Centers for Medicare and Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule rule for calendar year 2019 (MPFS2019). The proposal sets forth CMS-recommended updates to Medicare payment policies, payment rates, and quality provisions for services provided in the next calendar year. From year to year, the rule also can serve as a vehicle for soliciting input on new payment proposals and changes to existing policies. Among the payment and quality proposals in the MPFS2019 proposal, CMS proposed extensive changes to Current Procedural Terminology codes that are the framework for documentation and payment for office-based evaluation and management (E/M) services. The American Geriatrics Society (AGS) believes the proposed payment methodology changes for E/M services would have had a significant negative impact on care for older Americans. On September 10, 2018, the AGS submitted its comments on this proposal and other aspects of the rule, and the AGS also submitted a comment letter signed by 41 organizations from an AGS-led multispecialty coalition. The coalition also worked collaboratively on outreach to Congress, which included visits to Capitol Hill and a coalition letter stressing our collective support for reducing the burden of documentation for clinicians and our opposition to the proposed changes in payment methodology. In all letters, we noted that the AGS and members of our coalition hoped to work collaboratively with CMS and other stakeholders to develop a refined approach that would achieve the best possible outcomes for patients, particularly frail older Americans with multiple chronic conditions. In releasing their final MPFS2019, CMS postponed the E/M coding collapse for at least two years, a decision that speaks to the hard work of the AGS, its members, and the multi-specialty coalition, and which opens the door for further discussions about the future of payment for E/M services so critical to older people. J Am Geriatr Soc 67:145-150, 2019.


Assuntos
Tabela de Remuneração de Serviços/economia , Geriatria/economia , Serviços de Saúde para Idosos/economia , Medicare/economia , Idoso , Idoso de 80 Anos ou mais , Centers for Medicare and Medicaid Services, U.S. , Documentação/métodos , Tabela de Remuneração de Serviços/legislação & jurisprudência , Feminino , Geriatria/legislação & jurisprudência , Serviços de Saúde para Idosos/legislação & jurisprudência , Humanos , Masculino , Medicare/legislação & jurisprudência , Estados Unidos
15.
Fed Regist ; 83(220): 56922-7073, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30457290

RESUMO

This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2019. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). In addition, it updates and rebases the ESRD market basket for CY 2019. This rule also updates requirements for the ESRD Quality Incentive Program (QIP), and makes technical amendments to correct existing regulations related to the Competitive Bidding Program (CBP) for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Finally, this rule finalizes changes to bidding and pricing methodologies under the DMEPOS competitive bidding program; adjustments to DMEPOS fee schedule amounts using information from competitive bidding for items furnished from January 1, 2019 through December 31, 2020; new payment classes for oxygen and oxygen equipment and a new methodology for ensuring that new payment classes for oxygen and oxygen equipment are budget neutral; payment rules for multi- function ventilators or ventilators that perform functions of other durable medical equipment (DME); and revises the payment methodology for mail order items furnished in the Northern Mariana Islands. This rule also includes a summary of the feedback received for the request for information related to establishing fee schedule amounts for new DMEPOS items and services.


Assuntos
Equipamentos Médicos Duráveis/economia , Tabela de Remuneração de Serviços/economia , Tabela de Remuneração de Serviços/legislação & jurisprudência , Medicare/economia , Medicare/legislação & jurisprudência , Sistema de Pagamento Prospectivo/economia , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Diálise Renal/economia , Proposta de Concorrência/economia , Proposta de Concorrência/legislação & jurisprudência , Humanos , Estados Unidos
16.
Tex Med ; 114(10): 20-25, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30281774

RESUMO

Proposed overhaul to Medicare payments for complex patient care visits and same-day office-based procedures could box in Texas physicians.


Assuntos
Tabela de Remuneração de Serviços/normas , Visita a Consultório Médico/economia , Médicos/economia , Centers for Medicare and Medicaid Services, U.S. , Humanos , Medicare/economia , Texas , Estados Unidos
17.
Pain Physician ; 21(5): 415-432, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30282387

RESUMO

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare physician fee schedule and quality payment program, combining these 2 rules for the first time. This occurred in a milieu of changing regulations that have been challenging for interventional pain management specialists. The Affordable Care Act (ACA) continuous to be amended by multiple administrative changes. This July 12th rule proposes substantial payment changes for evaluation and management (E&M) services, with documentation requirements, and blending of Level II to V CPT codes for E&M into a single payment. In addition, various changes in the quality payment program with liberalization of some metrics have been published. Recognizing that there are differing impacts based on specialty and practice type, as a whole interventional pain management specialists would likely see favorable reimbursement trends for E&M services as a result of this proposal. Moreover, in comparison with recent CMS final ruling, this proposed rule has relatively limited changes in procedural reimbursement performed in a facility or in-office setting.CMS, in the new rule, has proposed an overhaul of the E&M documentation and coding system ostensibly to reduce the amount of time physicians are required to spend inputting information into patients' records. The new proposed rule blends Level II to V codes for E&M services into a single payment of $93 for office outpatient visits for established patients and $135 for new patient visits. This will also have an effect with blended payments for services provided in hospital outpatients. CMS also has provided additional codes to increase the reimbursement when prolonged services are provided with total reimbursement coming to Level V payments. Interventional pain management-centered care has been identified as a specialty with complexity inherent to E&M associated with these services. Among the procedural payments, there exist significant discrepancies for the services performed in hospitals, ambulatory surgery centers (ASCs), and offices. A particularly egregious example is peripheral neurolytic blocks, which is reimbursed at 1,800% higher in hospital outpatient department (HOPD) settings as compared with procedures done in the office. The majority of hospital based procedures have faced relatively small cuts as compared with office based practice. The only significant change noted is for spinal cord stimulator implant leads when performed in office setting with 19.2% increase. However, epidural codes, which have been initiated with a lower payment, continue to face small reductions for physician portion.This review describes the effects of the proposed policy on interventional pain management reimbursement for E&M services, procedural services by physicians and procedures performed in office settings. KEY WORDS: Physician payment policy, physician fee schedule, Medicare, Merit-Based Incentive Payment System, interventional pain management, regulatory tsunami, Medicare Access and CHIP Reauthorization Act of 2015.


Assuntos
Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Medicare/legislação & jurisprudência , Manejo da Dor/economia , Tabela de Remuneração de Serviços , Gastos em Saúde/legislação & jurisprudência , Humanos , Medicare Payment Advisory Commission , Patient Protection and Affordable Care Act , Sistema de Pagamento Prospectivo , Estados Unidos
20.
Fed Regist ; 83(92): 21912-25, 2018 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-30016834

RESUMO

This interim final rule with comment period makes technical amendments to the regulation to reflect the extension of the transition period from June 30, 2016 to December 31, 2016 that was mandated by the 21st Century Cures Act for phasing in fee schedule adjustments for certain durable medical equipment (DME) and enteral nutrition paid in areas not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). In addition, this interim final rule with comment period amends the regulation to resume the transition period's blended fee schedule rates for items furnished in rural areas and non-contiguous areas (Alaska, Hawaii, and United States territories) not subject to the CBP from June 1, 2018 through December 31, 2018. This interim final rule with comment period also makes technical amendments to existing regulations for DMEPOS items and services to reflect the exclusion of infusion drugs used with DME from the DMEPOS CBP.


Assuntos
Equipamentos Médicos Duráveis/economia , Tabela de Remuneração de Serviços/economia , Tabela de Remuneração de Serviços/legislação & jurisprudência , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/legislação & jurisprudência , Medicare/economia , Medicare/legislação & jurisprudência , Humanos , População Rural , Estados Unidos
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