The proposal would present a dangerous precedent for all of medicine.
On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule on the 2019 Medicare Physician Fee Schedule (CMS-1693-P). In what they say is an attempt to reduce physician burden, CMS is proposing to reform documentation requirements for evaluation and management (E&M) services in the following manner:
First, CMS would consolidate reimbursement for office-based and outpatient E&M visit levels 2 through 5 (i.e., CPT® codes 99202 through 99205 for new patients and CPT codes 99212 through 99215 for established patients) into a single flat-rate payment for new patients and established patients, respectively, regardless of which code(s) is billed. Documentation requirements would be the same as they currently are for level 2 codes (99202 or 99212, as applicable).
Second, CMS proposes to require podiatric physicians to use new “podiatrist-specific E&M codes:” G codes that were developed by CMS for podiatrists only. Such codes would require the same documentation as the standard E&M codes and reimburse at a significantly lower rate, despite representing the exact same services that all other physicians provide. This proposal violates statutory language in the Social Security Act, and looks as though it would present a dangerous precedent for all of medicine. Such drastic actions should concern everyone in the field.
Podiatrists are recognized as physicians under the Medicare statute. CMS’s proposals serve to provide differential payment to podiatrists with lower relative value units (RVUs) for the same E&M services. The most important thing to remember is this: The Social Security Act expressly prohibits differential valuation of services paid under the Physician Fee Schedule based on specialty.
This prohibition comes from Section 1848(c)(6) of the Social Security Act, which reads that “the Secretary may not vary the number of RVUs for a physician’s service based on the specialty of the physician.” CMS proposes that, rather than reporting visits under the general E&M code set, podiatrists would instead report visits under the aforementioned new G codes – which, according to CMS, more specifically value their services. However, CMS does not provide any rationale for why the services required for patients seeking care from podiatrists is distinct from that provided to patients with the exact same pathology and similarly complex care needs seeking medical care from other physicians. Much of the care provided by podiatrists is care that prevents pathology; it saves limbs, saves lives, and results in significant savings to the health-care system.
This proposal should concern everyone because it is a departure from how CMS has historically functioned and would establish scary precedent. And, what’s more, it begs the question: who could be next?
The good news is that this is only a proposed rule, and we all have the opportunity to do two very important things. One is to submit comments to CMS. The other is to write to your elected officials. We have spoken with many congressional leaders already. They are concerned about this violation of statutory language. They care about upholding the law, and about healthcare. They want to hear from their constituents. The more people they hear from, the better.
So go online, find out who your congressional representatives are where you live and work, and write to them using their websites to explain the violation of the Social Security statute described above. It is unfair to pay different specialists differently for the same service.
Be sure to submit comments to CMS by Sept. 10, 2018. You can do this at Regulations.gov by searching for the “2019 medicare physician fee schedule.”
It will be the fourth search result down, titled “Medicare Program: Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019.”
Comment now, and explain that while we appreciate the effort to decrease documentation burden, singling out podiatrists for separate codes with decreased reimbursement is not necessary to accomplish this goal.
The Centers for Medicare & Medicaid Services (CMS) released in its 2025 Outpatient Prospective Payment System (OPPS) Final Rule a new Conditions of Participation (CoPs)
External audit volume more than doubled in 2024 over 2023 while total at-risk dollars increased fivefold to $11.2 million, impacting healthcare provider organizations’ cash flow
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
