The Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees the Medicare program, is seeking comments on a proposed rule that would completely restructure how Medicare providers are paid. This new proposal could have significant, negative implications for people with Medicare. We encourage those who are interested in Medicare policy to let CMS know about your concerns before the comment period closes on Monday, September 10. Read below to learn what’s in the proposal and what you can do to respond before the deadline!
Currently, Medicare providers are paid through a complicated reporting process that involves a number of billing codes—where providers claim a certain level of reimbursement based, in part, on the complexity of the care they give. For example, providers are paid a smaller amount for simpler, shorter visits, and a larger amount for visits where more issues are handled and at a greater depth. Providers have raised concerns about this payment system, noting that it is difficult for them to know what level of visit they should claim and that the documentation is both time consuming in nature and prone to inaccuracies.
To purportedly ease the administrative burden on providers, CMS has proposed a complete overhaul of this process. At Medicare Rights, we are pleased that CMS is tackling this longstanding issue, but the details of the proposed solution are worse than the problem itself.
Instead of clarifying how the codes are to be used, CMS plans to collapse the codes together and pay only a flat fee per office visit—no matter how major or minor the visit is. This creates a situation where a 5-minute check in would be paid the same as an in-depth exploration of several significant conditions.
We fear such a system would incentivize providers to shorten visits and, in some cases, to schedule more visits to cover what could likely have been covered in a single, longer visit. Shorter, more frequent visits would mean more cost sharing for patients, and more burden in traveling to and from appointments. People in rural areas or those who rely on family or other caregivers would be especially harmed.
In the worst cases, it may drive some providers out of the Medicare program entirely, reducing people’s access to care. This would be particularly devastating for beneficiaries who rely on certain specialty providers and those who live in rural or underserved areas.
We support efforts to clarify the reimbursement codes for providers, but this is not the way to proceed. At the very least, CMS should run small tests on their proposals to ensure that it would not harm beneficiary access to care or increase financial or physical burdens.
Comments are due Monday, September 10, and Medicare Rights has made it easy for you to respond to this proposal. Here’s what you can do to weigh in and raise awareness:
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