decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 7 (July)
Pediatricians’ pay still tied to Medicare
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Article Overview
This article is for pediatricians, pediatric practice managers, and medical coders who track reimbursement trends. It covers the relationship between Medicare fee schedule changes and private payer contracts, the business impact of reimbursement fluctuations, and general contracting considerations for practices that base payment formulas on Medicare benchmarks. It also mentions selected CPT code examples used to illustrate how fee movements can affect pediatric reimbursement patterns.
Why This Topic Matters
Medicare payment changes can ripple into commercial contracts even for providers who do not bill Medicare directly. Understanding that connection helps pediatric practices anticipate reimbursement shifts and review contract language tied to Medicare-based formulas.
Article Sections
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Medicare fee schedule update and legislative response
Summarizes the midyear Medicare physician fee schedule situation and the federal action that affected whether a scheduled payment change would be implemented.
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What does Medicare have to do with me?
Explains why Medicare payment trends can matter to pediatricians through private payer reimbursement arrangements and contract benchmarking.
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Base contracts on good Medicare year
Discusses broad contract-management considerations for practices that reference Medicare-based payment formulas in payer agreements.
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Watch buffer codes
Reviews how certain commonly billed service categories may be affected differently by changes in the Medicare fee schedule.
What You Will Learn
- How Medicare fee schedule changes can influence pediatric reimbursement indirectly
- Why contract language tied to a Medicare year matters for private payer negotiations
- What general reimbursement trends practices may want to monitor when reviewing payer agreements
- How some frequently billed services may be impacted differently by fee schedule changes
Who Should Read This
- Pediatricians
- Pediatric practice managers
- Medical coders
- Reimbursement specialists
- Healthcare administrators
Codes Discussed
Code Ranges Discussed
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