March 21, 2014
The CMS physician fee schedule of 2014 and Medicare modalities have brought in an era of financial stress and reduced pay-outs for medical practitioners. Physicians are reluctantly admitting and accepting the payment cuts given their prior commitments for certain processes. Medicare on the whole has announced 2-6% of cut in various reimbursement ratios.
However, the new fee schedule is not just about reimbursement reductions and payment cuts, but stresses on other aspects of healthcare as well. Major changes in the 2014 physician fee schedule are as follows –
PQRS and e-Prescribing standards is one of the main changes that will affect medical practices under the fee schedule. The ACC has been offering medical practitioners an opportunity to participate in PQRS or Phyisician Quality Reporting System over the years to encourage a more comprehensive quality based and pay-for-performance healthcare service platform. Medical practitioners that have managed to adopt PQRS system of reporting nine measures under three different domains covering efficiency and patient safety will be eligible for 0.5% bonus in reimbursement in the year 2014. However, physicians and medical practices that have failed to show compliance to PQRS and e-prescribing standards will be facing reimbursement reduction to the extent of 1.5%. Next year this reduction will further be increased to 2% and after 2016, if practices are still not compliant with PQRS system of reporting then this reimbursement penalty can be increased even beyond 2%.
Another crucial change discussed in the physician fee schedule would be reduction in payment for technical components of low cost services. In an average day, if a medical practice is performing multiple procedures or services, then the payment for low cost services will be reduced by 20 -25%. In addition, therapeutic and diagnostic services will also be suffering from payment cuts by 20-25%. This would cause billers and coders to separate diagnostic services from episodic procedures in order to realize maximum reimbursements.
The RVU categories of work, practice expense and liability insurance have also undergone an approximate reduction of 4% in pay-out. Resultantly, services with higher practice expense will suffer reductions in reimbursement. While services with technical component will suffer some reductions under this guideline, primarily professional services will experience increase in reimbursement by 3% under this regulation.
The Affordable Care Act that mandates Medicare payment adjustments based on physician’s quality and resource usage is also another imminent change which will start getting manifested with this year’s fee schedule. Physicians are expected to collaborate and adopt a value based care system which would bring down the healthcare cost and get reimbursed based on the value delivered.
In times where healthcare reforms and Medicare modalities can affect your short term and long term financial feasibility, it is better to opt for professional medical billing services providers.
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ACA / HIPAA / Reforms