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Friday, June 20, 2014

Average family physician income up, but not equally

Family physician income, on average, has risen, but a new study indicates a greater number of family physicians are finding themselves on the low end of pay.

The 2013 Practice Profile Survey, a proprietary report issued in May, polled almost 500 American Academy of Family Physician (AAFP) members and found the average individual income in 2012 equalled $190,907. That's the highest average since the AAFP began surveying its members more than 30 years ago. However, the report noted that the median income was $170,000. A third of respondents said they earned $120,000 or less; a quarter of respondents said they earned more than $210,000.

"This suggests that the income levels among physicians are separating," the researchers wrote. "The separation is supported when the responses are categorized by income, as the percentage of respondents in the lowest category (earning $120,000 or less) was higher yet the mean income earned continued to grow."

When adjusted for inflation, the 2012 average still rises above previous years, but the median is similar.

Other survey findings include the following:

• Respondents said they worked an average of 48.3 hours a week in 2013, a decrease from 51.7 hours in 2012. Of that, they spent 34.1 hours in direct, face-to-face patient care, which was actually an increase from the previous year but similar to 2010 levels. The average amount of time spent on non-patient-care duties was down in 2013, falling to 2.6 hours per week, compared with 4.4 hours in 2012 and 4.8 hours in 2010.

• Sixty-eight percent of respondents said they were familiar with accountable care organizations (ACOs) and 28 percent said their practice was engaged in an ACO initiative. These are both increases over previous years as the ACO model continues to grow.

• Forty-two percent said they were familiar with the direct primary care (DPC) model. But only 2 percent of physicians said they currently worked in a DPC practice and 1 percent said they were transitioning to the DPC model.

• Twenty-six percent of respondents said their practice was recognized as a patient-centered medical home (PCMH), up from 24 percent the previous year. Nine percent said their practice had completed the transition and had applied for PCMH recognition. There was a slight decline in the percentage of physicians saying their practices received care management fees (44 percent), enhanced fee for service (37 percent), or shared savings amounts (13 percent) because of their inclusion in a PCMH. However, the percentage saying they received pay-for-performance amounts increased from 33 percent to 44 percent last year. Overall, 97 percent of respondents in a PCMH said their practice planned to reapply for PCMH recognition when the time came.

Tuesday, June 17, 2014

Potential pitfall in Medicare billing: office visits billed for hospital inpatients

This week, we conclude our series (see previous posts here, here, and here) on how to avoid common Medicare billing errors by focusing on billing the wrong kind of evaluation and management (E/M) code for patient visits provided in a hospital inpatient setting.

If you are rendering an E/M service to a patient in an inpatient hospital setting, then you should typically report that service with a CPT code from one of the following families:

•    99221-99223 – Initial hospital care
•    99231-99233 – Subsequent hospital care
•    99238-99239 – Hospital discharge services

Unfortunately, Medicare contractors are finding that physicians sometimes use a CPT code from the 99201-99215 family (Office or other outpatient services) for encounters with hospital inpatients. The example given is an 80-year-old female admitted to a hospital for an inpatient level of care on Oct. 17 and discharged on Oct. 20. A physician billed CPT code 99205 (Office or other outpatient visit for the evaluation and management of a new patient) for the date of service of Oct. 18. Because Oct. 18 was during the inpatient hospital stay and the patient was not on a leave-of-absence from the hospital on that date, the contractor deemed the service an overpayment.

So, if you are billing E/M services for a patient in an inpatient hospital setting, then you need to use hospital visit codes to report those services and avoid office/outpatient visit codes for dates of service corresponding to the patient’s hospital stay.

For additional information, check out Medicare’s Evaluation and Management Services Guide and sections 30.6.9.1, 30.6.9.2, and 30.6.10 of chapter 12 of the Medicare Claims Processing Manual.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, June 10, 2014

Potential pitfall in Medicare billing: modifer misuse

Over the past two weeks, we have discussed how to avoid common Medicare billing errors recently identified by the Centers for Medicare & Medicaid Services (CMS). This week, we’ll focus on the pitfalls associated with a commonly used billing modifier.

There are times when family physicians do multiple, separate procedures on the same patient at the same session or on the same day, for which separate payment may be allowed. Medicare rules state that the second and any subsequent procedures are subject to reduced payment in this situation. Physicians are to identify such services by appending modifier 51 (multiple procedures) to the codes for the second and subsequent procedures. Medicare, in turn, reduces the payment allowance by 50 percent for codes with modifier 51 attached.

Unfortunately, the CMS has identified situations in which physicians are appending modifier 51 to a procedure code even when that procedure is the only one provided to the patient on that date. In those situations, the physicians are generating inappropriate underpayments of up to 50 percent and shooting themselves in the foot financially. The easy answer is to NOT append modifier 51 to any code in the surgery section of Current Procedural Terminology (codes 10021 to 69990) if that is the only code from that section provided to the patient on that date.

For further resources, CMS advises that you read section 40.6 of chapter 12 and section 30 of chapter 23 of the Medicare Claims Processing Manual. Next week, we’ll wrap up this series of posts by looking at the pitfalls associated with billing office visits for hospital inpatients.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, June 3, 2014

Potential pitfall in Medicare billing: preventive services

Last week, we began looking at some of the common Medicare billing errors identified by the Centers for Medicare & Medicaid Services (CMS) in its most recent Medicare Quarterly Provider Compliance Newsletter. This week, we’ll focus on another of those pitfalls, this one associated with Medicare-covered preventive services.

In recent years, the CMS has expanded Medicare coverage of preventive services to include many recommended with a grade of A or B by the United States Preventive Services Task Force. These services (and their corresponding Medicare billing codes) include:

•    Annual alcohol misuse screening, 15 minutes (G0442)
•    Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes (G0443)
•    Annual depression screening, 15 minutes (G0444)
•    Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes (G0446)

Unfortunately, Medicare contractors have determined that insufficient documentation is causing many improper payments for these services. “Insufficient documentation” in this context means that something was missing from the medical records, such as:

•    No record of the amount of time spent providing a timed service
•    No record of the billed service itself
•    No physician’s signature on the medical record

To avoid these potential problems, CMS advises physicians to:

•    Record start and stop times, or the total time spent, when providing a timed service
•    Sign entries in medical records at the time of service
•    Learn about the non-covered indications and frequency limits for preventive services under Medicare

To the last point, you should know that:

•    Screening for depression is not covered when performed more than once in a 12-month period
•    Alcohol screening is not covered when performed more than once in a 12-month period
•    Brief face-to-face behavioral counseling interventions are not covered when performed more than once a day
•    Brief face-to-face behavioral counseling interventions are not covered when performed more than four times in a 12-month period.

You can find additional information and links to other relevant resources in the newsletter. Next week, we’ll look at the pitfalls associated with misuse of a common coding modifier.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, May 30, 2014

Potential pitfall in Medicare billing: psychotherapy in conjunction with an evaluation and management service

Four times a year, the Centers for Medicare & Medicaid Services (CMS) publishes its Medicare Quarterly Provider Compliance Newsletter, which seeks to help physicians avoid common Medicare billing errors. The latest issue highlights at least four errors that may be relevant to family physicians. This week, we’ll cover one related to psychotherapy provided in conjunction with an evaluation and management (E/M) service.

Family physicians are often the first point of contact for patients with mental health issues and sometimes provide psychotherapy to such patients in addition to an E/M service at the same encounter. Since January 2013, these services provided by the same provider on the same day are separately reportable and payable as long as they are significant, separately identifiable, and billed using the correct codes. In this situation, designated add-on codes are used to report psychotherapeutic services performed in addition to E/M codes.

Those CPT codes are:

•    +90833: Psychotherapy, 30 minutes with patient and/ or family member when performed with an E/M service
•    +90836: Psychotherapy, 45 minutes with patient and/ or family member when performed with an E/M service
•    +90838: Psychotherapy, 60 minutes with patient and/or family member when performed with an E/M service

CPT provides flexibility by identifying time ranges that may be associated with each of the timed codes:

•    90833: 16 to 37 minutes
•    90836: 38 to 52 minutes
•    90838: 53 minutes or longer

Psychotherapy sessions lasting less than 16 minutes are not separately reportable.

Documentation is crucial here. Time spent for the E/M service must be recorded separately from the time spent providing psychotherapy, and time spent providing psychotherapy cannot be used to meet criteria for the E/M service. Physicians can't enter one time period that includes both the E/M service and the psychotherapy.

CMS identified this blending of time periods as a common billing error in its quarterly newsletter. For example, a physician billed for a level 3 E/M service (99213) and 45 minutes of psychotherapy (90836). However, an authenticated printed visit note from the physician's electronic health record indicated total face-to-face time with the patient of 45 minutes and did not separately indicate the time spent providing psychotherapy services. The Medicare contractor, after an unsuccessful request for additional information, counted the claim as an overpayment due to insufficient documentation and recouped the payment from the physician.

Next week:  pitfalls associated with preventive services

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, May 29, 2014

Proposed delay but no reprieve for Meaningful Use

Health and Human Services (HHS) this month published a new proposed rule to its Meaningful Use program that would change what version of certified electronic health record technology (CEHRT) physicians must use and when they must attest for Stage 2. There are two groups of physicians that this new rule could affect:

All physicians attesting to Meaningful Use in 2014 – HHS proposes that if a physician has difficulty fully implementing a 2014 edition CEHRT because of a delay in availability in the market, they may use a 2011 edition CEHRT to attest to Meaningful Use in 2014.  The rule does not clarify what does and does not constitute a “delay in availability.” This may be clarified in the final version of the rule.

Physicians currently required to attest to Stage 2 – If you attested to Meaningful Use starting in 2011 or 2012, you were originally required to attest to Stage 2 of Meaningful Use this year. The proposed rule states that if you have difficulty fully implementing a 2014 edition CEHRT, you can (a) use a 2011 edition CEHRT to attest to Stage 1; (b) use a combination of 2011 edition and 2014 edition CEHRT to attest to either Stage 1 or Stage 2; or (3) still use a 2014 edition CEHRT and attest to Stage 2.

Be warned, however, that you will be required to complete your second year of Stage 2 attestation using a 2014 edition CEHRT starting Jan. 1, 2015. This means that although Stage 2 is delayed you do not have a reprieve to slow your implementation of a 2014 edition CEHRT. You will still need to perform the required Stage 2 activities at the first of the year.

The final tricky part is the federal rule-making bureaucracy. HHS must submit a notice of proposed rule making, which is what we are discussing now, before then requesting public comment, and then publishing a final rule. While it is extremely likely that this flexibility in using CEHRT and attesting to Stage 2 will be in the final rule, it may be changed by then. However, the marketplace asked for this flexibility, so it is hard to believe that the final rule would change dramatically.

– Steven E. Waldren, director of the Alliance for E-Health Innovation

Friday, May 23, 2014

Opportunity to review Open Payments data is approaching

The release in April of Medicare payments made to individual physicians caused its share of headaches and hand-wringing among practitioners who claimed that some of the information was incorrect or could be interpreted poorly by the public without the proper context.

Later this summer, another round of public filings could make life difficult. The Centers for Medicare & Medicaid Services (CMS) will begin releasing data from pharmaceutical and medical device manufacturers and group purchasing organizations on all financial interactions they've had with individual physicians and teaching hospitals.

Open Payments (you may remember it when it was called the Sunshine Act) is scheduled to release data for the final five months of 2013 by the end of September this year. Described as a way to provide more transparency to the financial relationships between physicians and their suppliers, the program tracks any payment or transfer of value of more than $10 from an applicable vendor to a physician. Beginning next year and thereafter, the Open Payments releases will cover an entire year.

Unlike the Medicare payments release, physicians will have a shot at reviewing the information submitted by manufacturers and attempting to correct any errors before publication.

Beginning June 1, eligible practitioners will be able to register for the CMS Enterprise Portal. This is considered the first step and must be completed before physicians, beginning in July, can register in the Open Payments system itself. That registration will gain the physician access to any manufacturer information reported about him or her, as well as allow the physician to dispute any payments he or she believes are inaccurate.

For more information on the Open Payments program, the CMS has a web site, complete with a downloadable user's guide.

Thursday, May 22, 2014

One-stop shopping Medicare quality reporting programs

One of the downsides to participating in multiple Medicare quality reporting programs, such as the Physician Quality Reporting System (PQRS) or Meaningful Use, is that you often have had to report the same data separately for each.

The Centers for Medicare & Medicaid Services (CMS) has heard your woes, however, and created a new interactive tool that will help you submit your quality data one time only and earn credit for multiple programs.

The “Reporting Once for 2014 Medicare Quality Reporting Programs” tool provides guidance based on how you plan to participate in PQRS in 2014:

•    As an individual eligible professional
•    As part of a group practice
•    As part of a Medicare Shared Savings Program Accountable Care Organization (ACO)
•    As part of a Pioneer ACO

Using the interactive tool, you will learn whether you will be eligible for PQRS incentives in 2014, will avoid PQRS Medicare penalties in 2016, and can satisfy the clinical quality measure component of the Medicare Electronic Health Record (EHR) Incentive Program. If you are part of a group practice with 10 or more eligible professionals, the tool will also help you assess the impact of your participation in PQRS on the Value-Based Payment Modifier.

You can use these streamlining options only if you have participated in the Medicare EHR Incentive Program for more than a year, and you are still required to report your core and menu objectives through the CMS Registration & Attestation System.

To use the interactive tool, simply click on the green “Start” button on page two of the tool. You can also use the “How to Report Once for 2014 Medicare Quality Reporting Programs” fact sheet  for an overview of the quality programs and reporting once in 2014.

For step-by step instructions for 2014 PQRS participation, view the PQRS How to Get Started web page on the CMS web site. If you have additional questions, contact the QualityNet Help Desk at 866-288-8912 or via qnetsupport@hcqis.org. The Help Desk is available Monday through Friday from 7:00 a.m. to 7:00 p.m. (Central Time).

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, May 13, 2014

Time to register for the 2014 group practice reporting option (GPRO)

This blog recently discussed how to avoid a Medicare payment adjustment under the Physician Quality Reporting System (PQRS) in 2016. We'll focus on one of those methods, meeting the satisfactory reporting requirement for the group practice reporting option (GPRO), registration for which is now available under the 2014 PQRS.

The program defines a “group practice” as a physician organization with its own single tax identification number (TIN) and two or more eligible professionals (EPs) who have individual national provider identifiers and have reassigned their billing rights to the TIN. When your group is ready, you can register through the Physician Value-Physician Quality Reporting System (PV-PQRS) at http://portal.cms.gov. To choose your group's reporting mechanism, you will need a valid user identification and password for authorized access to the Centers for Medicare & Medicaid Services' (CMS). The registration system for the 2014 PQRS program will be open until Sept. 30.

GPRO participants who satisfactorily report data on PQRS measures during the 2014 reporting period (Jan. 1-Dec. 31) are eligible for a 0.5 percent incentive and will avoid the 2 percent pay cut in 2016. This is the last year that EPs can earn an incentive payment under PQRS.

The report those measures, GPRO participants can choose one of three mechanisms:

•    Qualified PQRS registry
•    Directly from an electronic health record (EHR) using certified EHR technology (CEHRT)
•    CEHRT via a data submission vendor

If your group has 25 or more EPs, you can also participate in GPRO via Web Interface. If the group practice has 25 or more EPs, then the group can elect to supplement its PQRS reporting mechanism with the Clinician and Group Consumer Assessment of Health Providers and Systems (CAHPS) survey. However, if the group practice has 100 or more EPs and has selected the Web Interface reporting mechanism for 2014, then the group is required to report the CAHPS survey.

Additional information about the 2014 GPRO registration and 2014 PQRS GPRO requirements is available on the CMS web site. For more information on how to register in the PV-PQRS Registration system, please visit the Self Nomination/Registration page. Finally, for questions about how to register, please contact the Quality Net Help Desk at 866-288-8912 (TTY: 1-877-715-6222), or by email: qnetsupport@hcqis.org.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, May 6, 2014

Update on ICD-10 delay

A previous post noted that the Protecting Access to Medicare Act of 2014, which was enacted on April 1, 2014, said that the Secretary of Health and Human Services (HHS) may not adopt ICD-10 before Oct. 1, 2015. The law, however, did not limit when the Secretary could adopt ICD-10 beyond that date.

Accordingly, the Centers for Medicare & Medicaid Services (CMS) announced last week that the Secretary of HHS expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015. The rule will also require Health Insurance Portability and Accountability Act covered entities to continue to use ICD-9 through Sept. 30, 2015.

CMS also announced that it has canceled the ICD-10 end-to-end testing that it otherwise planned to conduct during the week of July 21. CMS canceled the July testing due to the ICD-10 implementation delay and said additional opportunities for end-to-end testing will be available in 2015.

Meanwhile, the acknowledgment testing that occurred in March was apparently a success. CMS previously reported that from March 3 to March 7 they received approximately 127,000 ICD-10 acknowledgment test claims, representing about 5 percent of those who submit claims to Medicare. CMS and its contractors encountered no systems problems associated with those test claims. CMS had originally planned to offer another week of acknowledgment testing this month; there is no word yet on whether it will still do so or postpone that to 2015 as well.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, May 1, 2014

Acting now to avoid a PQRS payment adjustment in 2016

While 2016 is more than a year and a half away, what you do in 2014 will determine whether or not you are subject to a Medicare payment adjustment under the Physician Quality Reporting System (PQRS) in 2016. In essence, you must satisfactorily report data on quality measures during 2014 to avoid the 2016 payment adjustment.

You can avoid the 2016 payment adjustment by meeting one of the following criteria during the one-year 2014 reporting period (Jan. 1-Dec. 31, 2014):

  • If participating as an individual eligible professional: Meet the criteria for satisfactory reporting adopted for the 2014 PQRS incentive. Or, participate in PQRS via qualified clinical data registry, qualified registry, or claims reporting and report at least three measures covering one National Quality Strategy (NQS) domain for at least 50 percent of your Medicare Part B fee-for-service (FFS) patients.

  • If participating as a group practice: Meet the Group Practice Reporting Option requirements for satisfactory reporting. Or, participate in PQRS via qualified registry reporting and report at least three measures covering one NQS domain for at least 50 percent of your group practice’s Medicare Part B FFS patients.

More information is available via the PQRS web page on the Centers for Medicare & Medicaid Services' website. You may especially want to look at their new fact sheet for guidance on how to avoid the 2016 PQRS payment adjustment. You can also contact the QualityNet Help Desk 7 a.m.-7 p.m. (Central Time), Monday through Friday, by calling 866-288-8912 (TTY: 877-715-6222) or by sending an email to qnetsupport@hcqis.org.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, April 22, 2014

Dealing with the opportunities and threats of the new Medicare data release

This month's release by the Centers for Medicare & Medicaid Services (CMS) of a public use file on Medicare physician utilization and payment data creates both opportunities and threats for family physicians. We're going to consider both.

On the plus side, the release of the Medicare data provides a great opportunity for the family medicine community to highlight the complexity of care that family physicians provide. Also, the data show wide variation in total payments made among various medical specialties, which reinforces the point that primary care physicians are underpaid relative to other specialists and sub-specialists. When that data set is further studied, it may make the case that family physicians, who provide comprehensive and time-intensive health care to their patients, are undervalued from a payer perspective.

On the other hand, the Medicare data set has lots of limitations. For example, physicians weren't given an opportunity to review the data for potential errors; the data don't measure the quality of care provided; there's no allowance for residents or nurse practitioners filing claims under a physician's national provider identifier, meaning the payment numbers could be inflated; Medicare payments may not always cover the costs of treatment, which makes the numbers an inaccurate portrayal of physician compensation; the data are not risk-adjusted, don't account for patient mix or include care for private insurance patients or Medicaid beneficiaries; the numbers don't reflect the often higher reimbursements provided in facility settings versus a physician's office; and they don't consider changes in Medicare's coding and billing rules that may different over time and across regions of the country.

Those weaknesses presents several threats:

•    Insurers, hospitals, and accountable care organizations could use the data to assess physicians’ charges and potentially drop those individuals deemed to be high-cost physicians.
•    Public and private insurers might use the data as a reason to impose additional prior authorization requests for expensive Part B drugs.
•    The data set has the potential to paint a negative picture of some physicians with patients, and it also has the potential to further enhance the perception that physicians are overpaid relative to the average U.S. worker.

Finally, the data may generate some difficult questions from patients or local media. Here are some points to emphasize if you find yourself in such a conversation:

•    Greater transparency in the health care system is a laudable goal, and there is potential value in the release of Medicare payment data for ensuring the quality of care for patients and efficient use of resources in the delivery of health care services.
•    Release of this data shines a light on the need to reform physician payment away from fee-for-service and toward payment for quality of care.
•    Data should include context and background on physician payments so that policy makers, patients, and the public understand the overall quality of care their physicians provide.
•    The data release still needs safeguards to ensure that neither false nor misleading conclusions are derived from this information, which has its limitations.
•    Medicare payment information by itself does not describe a physician’s practice.
•    Hopefully, researchers will use this data to understand and improve how health care dollars are spent, so that we can also improve the health of patients, families, and communities.

Whether the potential opportunities outweigh the potential threats remains to be seen. However, knowing what they are provides a starting point for trying to maximize the former while minimizing the latter. For more information on this subject, check out the AAFP's "Physician Payment Transparency" web page and read the frequently asked questions on the CMS website.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Monday, April 21, 2014

Family physician compensation continues to disappoint

The income disparity for family medicine is taking a toll, according to a new survey.

In the Medscape Compensation Report for 2013, released earlier this week, physicians were asked if they still would have pursued a medical career if they had to do it all over again. Sixty-seven percent of family physicians surveyed said they would have but only 32 percent said they would have stuck with family medicine. By comparison, 58 percent of all physicians surveyed said they would still have gone into medicine with 47 percent sticking with their current specialty.

Other parts of the report reveal hints of what might be causing so many family physicians to wish they had a time machine.

For example, family physicians reported an average compensation of $176,000 last year, the second-lowest among the 25 specialties surveyed. Family medicine beat out only HIV/infectious disease physicians, who made an average of $174,000. The most lucrative specialties last year were orthopedics and cardiology, with average compensation of $413,000 and $351,000, respectively.

Only half of family physicians said they felt fairly compensated, which placed the specialty in about the middle of the pack. Dermatologists seemed to be the happiest with 65 percent expressing overall career satisfaction.

Forty-two percent of family physicians said they spent 40 hours or more each week serving patients while more than two-thirds said they saw 76 patients or more each week. Sixteen percent said they saw 125 patients or more each week.

In terms of family medicine practice environments, the researchers found the highest average compensation among those working in hospitals ($191,000), health care organizations ($190,000) and office-based multispecialty group practices ($187,000). The lowest average belonged to office-based solo physicians ($158,000).

Also, 29 percent of family physicians said they belonged to an accountable care organization (ACO) last year and another 11 percent said they plan to join within a year. By comparison, only 5 percent belonged to an ACO in 2011.

Wednesday, April 16, 2014

Medicare releases physician claims data for public consumption

Last week, the Centers for Medicare & Medicaid Services (CMS) released on its website a data set detailing payments made in 2012 to more than 880,000 physicians from the Medicare Part B Fee-for-Service program.

The release of the physician claims data came in response to a legal challenge from the Wall Street Journal, which successfully argued for a federal judge to lift a 1979 injunction preventing CMS from publishing the information. CMS initially planned to evaluate requests for physician payment information on a case-by-case basis. But after receiving numerous requests for the Medicare data, CMS determined the Freedom of Information Act (FOIA) required it to make frequently requested materials available electronically and publicly release certain physician payment information on its website.

This information represents revenue from Medicare Part B services before the practice’s operating costs are deducted. It doesn't include information from Medicare Part A (Hospital Insurance), Part C (Medicare Advantage), Medicaid, Marketplace, or private insurance plans. The data also does not include information associated with clinical diagnostic laboratories or durable medical equipment. Further, this data set does not represent each medical practice’s entire patient panel, and it is not risk-adjusted for severity and complexity of patients treated by the physician. 

The file contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier, Healthcare Common Procedure Coding System code, and place of service.

Physicians and others can access this information by downloading files split by provider last name from the CMS web site. Alternatively, the New York Times and the Wall Street Journal have created tools to search this data by name, specialty, and city/ZIP code.

In future posts, we’ll talk about potential implications of this data release, further limitations of the data, and possible questions you may get from your patients. In the meantime, be aware that the data is out there and that CMS is not the only one looking at it anymore.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Wednesday, April 9, 2014

SGR, ICD-10 not the only targets of adopted legislation

Last week's SGR legislation didn't just push back Medicare cuts and delay ICD-10 implementation.

A new blog post by Betsy Nicoletti notes that the 123-page bill passed by Congress and signed into law by President Obama also requires additional reporting for lab test reimbursements and creates greater scrutiny of CT scans.

Read the blog here: http://www.kevinmd.com/blog/2014/04/sleight-hand-sgr-bills-important-policy.html

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The views expressed here do not necessarily reflect the opinion of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. See Terms of Use.