decisionhealth Newsletters, Part B News - 2001 Issue 11 (November)
Groups representing your interests want practice expense tweaks
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Article Overview
This article covers how physician specialty groups are responding to Medicare’s move to resource-based practice expense payments and what kinds of refinements they want CMS and Congress to consider. It is relevant to physicians, practice managers, coders, and reimbursement professionals who follow Medicare payment policy, specialty survey methodology, and relative value updates. The discussion focuses on broad payment-policy concerns, specialty survey input, and the roles of CMS, AMA committees, and physician organizations.
Why This Topic Matters
Practice expense values affect Medicare reimbursement and can influence where services are performed, how practices staff procedures, and how specialty groups advocate for payment changes. Understanding these debates helps coding and reimbursement professionals track policy shifts that may affect office-based and facility-based services.
Article Sections
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Resource-based practice expense payments
Introduces Medicare’s transition to a resource-based practice expense payment approach and describes the broad specialty groups affected by the change.
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Site-of-service concerns and cardiology advocacy
Summarizes concerns from cardiology representatives about differences tied to office and facility settings and the impact on practice economics.
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Unhappy with the SMS
Discusses specialty reactions to practice expense survey data, including concerns about survey size, methodology, and CMS acceptance of submitted information.
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Clinical staff time
Addresses disputes over how clinical staff resources are treated in practice expense values and the differing views of specialty groups and CMS.
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Not everyone critical
Notes that some primary care organizations report relative satisfaction with current practice expense payments and are focusing on narrower refinements.
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Specialties can slug it out in the PEAC
Describes the AMA committee forum used for practice expense refinement discussions and the limits some groups see in that process.
What You Will Learn
- How Medicare’s resource-based practice expense system changed payment calculations
- Why some specialties are seeking practice expense refinements
- What concerns groups raise about survey methodology and data acceptance
- How specialty organizations participate in practice expense review processes
- Why some physician groups are more satisfied with current payment updates than others
Who Should Read This
- Physicians
- Medical coders
- Practice managers
- Reimbursement specialists
- Health policy analysts
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