tci Medicare Compliance & Reimbursement - 2014 Issue 1
Reimbursement: Innovative Approach To Handling Patients With Chronic Issues Proposed
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Article Overview
This article summarizes CMS’s proposed Physician Fee Schedule changes and the potential effects on Medicare reimbursement across specialties. It also covers the agency’s proposed approach to separate payment for complex chronic care management services beginning in 2015, including the broad service framework, practitioner participation, and patient consent and documentation themes. It is relevant to physicians, non-physician practitioners, practice managers, coders, and reimbursement professionals following Medicare payment policy.
Why This Topic Matters
The proposed rule could affect payment levels for multiple specialties and introduces a new reimbursement concept for ongoing chronic care services. Readers working in billing, coding, and practice administration need to understand the scope of the proposal and its possible operational impact.
Article Sections
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Conversion factor projection and payment impacts
Discusses the proposed Physician Fee Schedule and estimated reimbursement changes affecting different provider groups and service categories.
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Hope for chronic care management fees in 2015
Introduces CMS’s proposed separate payment framework for complex chronic care management services beginning in 2015 and outlines the broad service model.
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Consent, documentation, and practitioner continuity
Covers the proposed requirements related to patient agreement, recordkeeping, practitioner involvement, and coordination across care settings.
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Proposed G codes for chronic care services
Notes that CMS plans to create two new HCPCS G codes for the chronic care service structure and describes their general timing and scope.
What You Will Learn
- How CMS’s proposed Physician Fee Schedule may affect Medicare payment levels
- What types of providers and specialties are discussed in the reimbursement outlook
- The general concept behind CMS’s proposed chronic care management payment approach
- The administrative themes tied to consent, continuity, and documentation for the proposed services
- The article’s broad discussion of new HCPCS G code creation for chronic care services
Who Should Read This
- Physicians
- Non-physician practitioners
- Medical coders
- Billing staff
- Practice managers
- Reimbursement specialists
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