Texas Doctors Fighting Proposed Streamlined Medicare Processes

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Last week, we reported on proposed changes to Medicare requirements that are intended to streamline coverage and participation conditions. 

At least one state, Texas, is objecting to some of the proposed provisions and is working to make sure that its physicians can continue to see Medicare patients and stay in business.

The Texas Medical Association is taking advantage of the comment period – open through November 1 – to persuade the Centers for Medicare & Medicaid Services (CMS) to reconsider many of its proposals.

Will Specialists Lose Under New Requirements?

Part of the proposed changes center on the Medicare billing structure. The new scheme would have only two payment levels: level 1 and a collapsed second category, rather than the five categories available today. 

The condensed categories would restrict billing and specialties like neurologists, internal medicine physicians and rheumatologists would be forced to accept reduced billing rates. These types of care often require complex office visits that take a significant amount of time, such as when obtaining lengthy patient histories.

Another potential ramification that has Texas providers concerned is that of a “ripple effect” on private insurance payments. Many commercial insurers link their billing rates to those of Medicare. 

The door is not yet closed to modifying the proposals. CMS may be considering new “add-on” payments that may bump up payment for those patients who are more complex, according to a Texas Medicine article. CMS also reiterated to the Texas Medical Association that the reduced time spent on the new documentation requirements would allow health care providers to continue to spend more time on their patients.

It will be very interesting to see what shape the final Medicare procedures take. Stay tuned to more information on this topic as the comments period closes and CMS issues its final update.

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