decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 12 (December)
Medicare will end consult payment, cut physician fees 21.2% in 2010
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Article Overview
This article reviews major 2010 Medicare physician fee schedule changes and the policy context behind them. It covers the elimination of Medicare payment for most consultation services, related shifts in office and hospital visit billing, telehealth-only exceptions, and the expected impact of the conversion factor change on physician reimbursement. The piece is relevant to coding professionals, billing staff, compliance teams, and medical practices that submit Medicare claims or coordinate payment with secondary payers.
Why This Topic Matters
These fee schedule changes affect how common evaluation and management services are reported and reimbursed under Medicare. The article helps practices understand the scope of the policy shift and anticipate administrative and financial impacts.
Article Sections
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Medicare physician fee schedule changes for 2010
Introduces the fee schedule update, including the broader reimbursement environment and expected changes affecting physician payments.
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Removal of consultation payment and related billing changes
Summarizes the Medicare policy change affecting consultation services and the shift to other visit categories in office and hospital settings. It also notes the related administrative issues involving Medicare and secondary payers.
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Telehealth consultation exceptions
Describes the limited consultation services that remain payable under Medicare for telehealth delivery and identifies the new G-codes associated with that category.
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RVU and fee impact on office and hospital visits
Explains the general direction of relative value unit adjustments and the expected effect on reimbursement for common office and hospital visit services.
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Congressional response and payment reform legislation
Covers the legislative response being considered and the uncertainty surrounding whether a temporary or permanent payment fix will occur.
What You Will Learn
- How the 2010 Medicare physician fee schedule affects consultation-related payment policies
- What categories of evaluation and management services are impacted by the Medicare change
- Which broad types of telehealth consultation services remain under Medicare payment
- How the policy change may affect claims coordination with secondary payers
- What legislative actions were being considered in response to the physician payment cut
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practices
- Revenue cycle teams
- Healthcare administrators
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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