Our fees have been cut by 21%, and Medicare won’t pay for consults anymore! What a disaster!

By  |  December 29, 2009 | 

John Nelson writes….

Fortunately, the reality isn’t nearly so grim.  In fact, there is some good news here.  If you fell for my intentionally misleading headline, then you might benefit by catching up on the latest news on these two issues.

The first issue is the scheduled 21% reduction in the rate at which Medicare reimburses providers.  This issue comes up every year at this time as a result of Medicare’s Sustainable Growth Rate (SGR) formula.  Reductions in reimbursement rates are all set to happen based on the SGR, but Congress always intervenes to prevent the cuts, and sometimes even approves increases in reimbursement.  This has been going for many years, and this year is no exception…  so far.  Comprehensive health reform might still result in reductions in the rates we’re paid by Medicare, but probably through formulas and reasoning not connected to the SGR.  SHM’s homepage will have updates about all this under the “News” and “SHM Initiatives” sections.  This information is current as I write, but will be updated regularly in the future.

The other part of my headline above refers to Medicare dropping consult codes.  Most hospitalist groups will benefit from this change; at least a little.  The only problem is that it is a little tedious to figure out exactly what codes and modifiers we should be using as of January 1, 2010.  The latest information I’m aware of is here.  But I suspect the “rules” governing the choice of appropriate codes will continue to evolve some in the coming months.  Stay tuned…

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