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Friday, September 2, 2016

Understanding what Medicare expects when ordering diabetes supplies

Sometimes, it’s not about getting paid. Sometimes, it’s about getting your patients what they need with the least amount of hassle and paying yourself with the time saved.

One of the ongoing sources of frustration for family physicians is helping their Medicare patients with diabetes receive the testing supplies they need to help manage their condition. Physicians have to continually order refills even though they know the patients will need to test for the rest of their lives and have to specify the brand name of the products they are ordering even though, from a clinical standpoint, the name of the brand doesn’t matter. Apparently, “diabetic testing supplies” is inadequate for Medicare purposes.

So, what do the Medicare administrative contractors (MACs) that process claims for glucose monitors and related supplies (e.g. lancets and test strips) expect from physicians? One of the MACs recently attempted to address that question.

For glucose monitors, Medicare requires the following prior to delivery by a supplier:

•    A face-to-face visit with the prescribing practitioner within six months before prescribing, including documentation that the patient was evaluated, treated or both for diabetes mellitus supporting need for the glucose monitor ordered,
•    An order that includes:
     o    Patient name
     o    Item ordered
     o    National Provider Identifier
     o    Date of the order
     o    Prescribing practitioner signature

Other diabetes testing supplies, such as test strips and lancets, require a detailed written order to the supplier. The detailed written order must contain:

•    Beneficiary's name
•    Prescribing practitioner’s name
•    Date of the order
•    Detailed description of the item(s)
•    Frequency of use or testing
•    Quantity to be dispensed
•    Number of refills
•    Prescribing practitioner’s signature and signature date

Be aware that there are limits to the quantity of test strips and lancets that Medicare covers when the basic coverage criteria are met. For beneficiaries treated with insulin, this limit is 300 every three months. For beneficiaries not receiving insulin, the limit is 100 every three months.

Medicare will cover quantities above these limits, but you have to document additional criteria in your patient’s medical record and be prepared to make that documentation available upon request. These additional documentation requirements are that you have seen and evaluated the beneficiary’s diabetes within six months of ordering supplies in excess of the normal amounts and have documented in the medical record the specific reason for the additional supplies. Also, you need:

•    Medical records documenting frequency of actual testing by beneficiary;
•    Specific narrative that documents frequency beneficiary is actually testing; or
•    Copy of the beneficiary’s testing log (must be provided to physician by beneficiary).

This guidance will not solve all of the hassles associated with getting your Medicare patients with diabetes the testing supplies they need. However, if it helps you get your patients the items they need faster, then so much the better for you, them, and Medicare. 

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

Friday, August 19, 2016

CMS clarifies the new lab reporting requirement

Last month, we highlighted a new rule from Medicare that requires certain clinical labs to report how much they receive from private insurers for lab tests. Now, the Centers for Medicare & Medicaid Services (CMS) has issued guidance to help labs meet the new requirements by clarifying some of the who, what, and when related to the new rule.

With respect to “who,” labs can use a four-question test to determine if the new rule applies to them:

• Is the lab certified under the Clinical Laboratory Improvement Amendments (CLIA)?
• Does the CLIA-certified lab bill Medicare Part B under its own national provider identifier?
• Does the lab meet the majority of Medicare revenues threshold?
• Does the lab meet the low expenditure threshold?

To answer “what,” CMS lays out the three major types of information that affected labs must collect and report:

• The specific billing code associated with a test
• The private payer rate for each test for which final payment has been made during the data collection period
• The associated volume for each test

Finally, in terms of “when,” the guidance defines the first data collection and reporting periods:

• Labs affected by the rule must collect applicable information from all claims for which the lab received final payment between Jan. 1 and June 30 of this year.
• Labs must submit that information to CMS between Jan. 1 and March 31 of next year.

During the six-month window between the end of the data collection period and the beginning of the data reporting period, CMS expects laboratories and reporting entities to assess whether the applicable laboratory thresholds are met.

As noted in our original post, CMS estimates this new rule will include only 5 percent of physician office labs and about half of independent labs. For those that fall in that category, the new guidance is essential reading.

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

Thursday, August 11, 2016

It’s not too early to prepare for diagnosis code changes

Changes are coming to the ICD-10-CM code set. Effective with services provided on or after Oct. 1, ICD-10 diagnosis codes will update to the 2017 version.

The update will affect some of the diagnosis codes used in family medicine. For instance, one of the most significant changes is the addition of a new code, R73.03, for “Prediabetes.” Another example is coding for “familial hypercholesterolemia.” If you had to code that today, you would use E78.0 (Pure hypercholesterolemia). The 2017 version of ICD-10 replaces E78.0 with two new options:

•    E78.00 (Pure hypercholesterolemia, unspecified)
•    E78.01 (Familial hypercholesterolemia)

Similarly, ICD-10 is adding three new codes to report joint pain in the hands:

•    M25.541 (Pain in joints of right hand)
•    M25.542 (Pain in joints of left hand)
•    M25.549 (Pain in joints of unspecified hand)

These are just some of the changes relevant to family medicine. Crosschecking the diagnosis codes you use most often (e.g., the ones listed on your superbill) against the 2017 ICD-10-CM code set would be a good place to start in preparing for the update.

You can access the new ICD-10 code set and other related resources through the Centers for Medicare & Medicaid Services ICD-10 web site. The American Academy of Family Physicians also has ICD-10 resources on its web site, including AAFP Coding Flashcards for 2017.

Diagnosis code changes are coming. Are you ready?

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

Thursday, August 4, 2016

Comprehensive Primary Care Plus regions announced

Back in April, the Centers for Medicare & Medicaid Services (CMS) unveiled its latest model of practice transformation and primary care delivery, Comprehensive Primary Care Plus (CPC+). This new model is available only for a limited time and in limited areas – but those areas have finally been announced.

CMS has selected 10 states (Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee) and four more specific regions (the Greater Kansas City region in Missouri and Kansas, the North Hudson-Capital region of New York, a region covering all of Ohio and northern Kentucky, and the Greater Philadelphia region of Pennsylvania).

CMS chose these regions based on the 57 commercial payers who CMS selected to participate in the program and who wil support CMS’s payment model. A full list of participating payers by region can be downloaded on the CMS CPC+ webpage. CPC+ is expected to involve up to 5,000 practices and more than 20,000 physicians and other clinicians serving up to 25 million patients.

Individual physicians and practices in the designated regions can apply to participate through the CPC+ Online Application Portal through Sept. 15. Practice application questions can be found in the Request for Applications.

CMS is offering additional answers to CPC+ Practice Frequently Asked Questions and webinars called Open Door Forums focused on various CPC+ program topics. The AAFP is also partnering with Caravan Health to help practices prepare for the requirements of CPC+ through Caravan Health's Boot Camp.

Physicians participating in the five-year program, which is scheduled to begin Jan. 1, must choose one of two tracks focused on care management, access and continuity, planned care for population health, patient and family caregiver engagement, and care that is comprehensive and coordinated.

While Track 1 requirements are similar to the original CPC program’s milestones, Track 2 forces participants to push the envelope in terms of using health information technology, targeting patients with complex needs, and helping meet patients’ psychosocial needs.

Physicians participating in CPC+ will receive monthly care management fees for eligible beneficiaries in their practice. Physicians in Track 1 will be paid depending on where each patient falls across four risk tiers, with an average of $15 per beneficiary per month. In Track 2, physicians will be paid according to five risk tiers, with an average of $28 per beneficiary per month, including $100 per month for the most complex patients. Practices can use these fees for increased staffing and training necessary to meet the model’s patient care requirements.

In addition to the care management fees, Track 1 physicians will continue to receive their normal Medicare fee-for-service payments. Physicians in Track 2 will receive a new hybrid of fee-for-service payments and a “Comprehensive Primary Care Payment,” which will include a percentage of the expected Medicare reimbursement for Evaluation & Management (E/M) claims upfront. Reimbursement for the E/M claims themselves will be reduced.

— Kristen Stine, Practice Transformation Strategist for the American Academy of Family Physicians

Thursday, July 28, 2016

You'll need an EIDM account for this year's feedback reports

The Centers for Medicare & Medicaid Services (CMS) is encouraging physicians to sign up or reactivate their Enterprise Identity Management (EIDM) accounts now ahead of the release this fall of a pair of important feedback reports. EIDM accounts are required to access the information, and signing up now will prevent delays when the reports are released.

An EIDM account allows physicians to view and download their Physician Quality Reporting System (PQRS) feedback report and Quality and Resource Use Report (QRUR). The PQRS report provides information on your performance in 2015 and any payment adjustments for 2017. The 2015 QRUR includes information on how your practice fared on quality and cost measures as well as any payment adjustment you may receive under the Value-Based Payment Modifier. (For more information, see "What You Need to Know About Medicare's New 'Quality and Resource Use Report'," FPM, November/December 2015.)

To sign up for an account, visit the CMS Enterprise Portal website and click “New User Registration” located under the CMS Secure Portal heading. Once you’ve created your username and password, you will need to request access for the “Physician Quality and Value Programs.” From there you can select the type of role. Each organization must have at least one Security Official unless they are a solo practice, in which you would designate an Individual Practitioner. If you need assistance in signing up for an account or are unsure if you or someone in your practice already has an account, you can contact the QualityNet Help Desk at 866-288-8912.

CMS has created an EIDM System Toolkit containing guides on signing up for an account. It is a good idea to review this information before beginning the application process to make sure you have all the information you need. CMS make take several weeks to approve your role request, so it is important to begin this process as early as possible.

– Erin Solis is the Regulatory Compliance Strategist at the American Academy of Family Physicians

Tuesday, July 19, 2016

CMS to calculate new payment rates for lab tests

If your practice has an office laboratory, a new final rule issued by the Centers for Medicare & Medicaid Services (CMS) may affect you.

The rule requires that certain clinical labs report how much they receive from private insurers for lab tests as well as lab test volumes. CMS plans to use this information to calculate new Medicare payment rates under the Clinical Laboratory Fee Schedule (CLFS), beginning in 2018.

Only labs that receive at least $12,500 a year in Medicare revenues from laboratory services paid under the CLFS and more than half of their Medicare revenues from laboratory and/or physician services will have to report.

CMS estimates this will include only 5 percent of physician office labs and about half of independent labs. However, the information provided by those labs will help revise Medicare payment rates for everyone.

Under the plan, the affected labs will collect payer data from the first six months of this year and report it to CMS between Jan. 1 and March 31 of next year. CMS will then calculate the new Medicare rates, based on a weighted median of private payers for each test, and post them in early November 2017. They will go into effect Jan. 1, 2018.

For more information, see the CMS press release and detailed fact sheet.

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

Thursday, July 14, 2016

CMS looks to reduce 2016 meaningful use reporting period to 90 days

The Centers for Medicare & Medicaid Services (CMS) has proposed reducing the amount of time physicians and practices need to report to comply with the meaningful use (MU) program.

Originally, eligible professionals and eligible hospitals needed to report a full year’s worth of data from their electronic health records (EHRs) to meet the 2016 requirement and avoid a financial penalty.

But as part of a group of proposed policy and payment changes released earlier this month and published in the Federal Register this week, CMS says it would require those parties to submit data for any continuous 90 days between Jan. 1 and Dec. 31 of this year.

“We believe it would continue to assist health care providers by increasing flexibility in the program,” CMS said in a release, noting this is the same reporting period as in 2015.

CMS also said that physicians and hospitals who have not successfully attested to MU in a previous year would have to meet modified Stage 2 requirements by Oct. 1, 2017, instead of Stage 3.

Also, certain eligible professionals who have not successfully demonstrated MU in a previous year, plan to attest to MU in 2017, and plan to report data for the advancing care information performance category under the Merit-Based Incentive Payment System (MIPS) in 2017 can apply for a significant hardship exception from payment penalties in 2018.

CMS is accepting comments on the proposed rule though Sept. 6 before releasing a final rule.

If you don’t want to read the full proposed rule, CMS released a more succinct fact sheet

Monday, July 11, 2016

CMS releases proposed rule on 2017 Medicare physician fee schedule

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule on the 2017 Medicare physician fee schedule. Primary care physicians should be interested that the rule includes several proposed increases for care management services. Specifically, CMS is proposing to pay for:

•    Non-face-to-face prolonged evaluation and management services
•    Comprehensive assessment and care planning for patients with cognitive impairment
•    Primary care practices to use interprofessional care management resources to treat behavioral health conditions
•    Resource costs of furnishing visits to patients with mobility-related impairments
•    Chronic care management (CCM) for patients with more complex conditions

In addition, CMS proposes to reduce the administrative burden associated with the CCM codes to encourage more practices to furnish and bill for these services. CMS also will revalue existing codes describing face-to-face prolonged services.

For 2017, CMS estimates the conversion factor to be $35.7751, which is slightly lower than the 2016 conversion factor of $35.8043. However, CMS expects that the provisions of the proposed rule will generate an estimated 3 percent increase in Medicare allowed charges for family physicians. That would be the largest estimated update for a given specialty.

For individuals who don’t want to read the proposed rule itself, CMS has provided an abbreviated fact sheet and press release. CMS is accepting comments on its proposals through Sept. 6.

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

Thursday, July 7, 2016

JW modifier allows physicians to get paid for some discarded drugs

The Centers for Medicare & Medicaid Services (CMS) recently revised its guidance on how to use the JW modifier. Specifically, the revision will make it easier for physicians to get paid for leftover medication or biologicals that are properly thrown out.

Beginning Jan. 1 of next year, physicians must use the JW modifier for claims with unused drugs or biologicals from single-use vials or single-use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals). The physician must also document the discarded drug or biological in the patient's medical record when submitting Part B claims.

For example, imagine you administer 95 units of a drug from a single-use vial that is labeled to contain 100 units and discard the remaining five units. You bill the 95-unit dose on one line of the claim and bill the discarded five units on another line by using the JW modifier. Both line items would be processed for payment. You apply the JW modifier only to the amount of drug or biological that is discarded.

You may not use the JW modifier when the billing unit is equal to or greater than the total actual dose and the amount discarded. For example, if one billing unit for a drug is 10 mg in a single-use vial and you administer 7 mg and discard the remaining 3 mg, you can bill the 7 mg dose as one 10 mg unit. You could not also bill the discarded 3 mg on a separate line item with the JW modifier because that would result in overpayment.

Medicare administrative contractors currently have discretion over whether to require the JW modifier for any claims with discarded drugs or biologicals, and how the discarded drug or biological information should be documented. CMS is revising this policy to create more uniformity for these types of claims.

For additional information on billing Medicare for discarded drugs and biologicals, see section 40 of chapter 17 of the Medicare Claims Processing Manual.

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

Tuesday, June 28, 2016

CMS places some limits on review of Medicare claim denials

If you’ve ever appealed a Medicare claim denial only to see it struck down for new reasons that the reviewers found in the course of their review, help may be coming.

The Centers for Medicare & Medicaid Services (CMS) recently told its Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) to change how they review certain claim denials. Specifically, CMS says they should limit their review of redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review to the reason or reasons the claim or line item was denied in the first place.  

CMS acknowledged that MACs and QICs generally have discretion while conducting appeals to develop new issues and review all aspects of coverage and payment related to the claim or line item. As a result, while the original reason for the denial may be resolved, this expanded review may result in a denial of the appeal for new reasons. The revised instructions prohibit the contractors from doing that in certain situations, which is good news for physicians and others who initiate such appeals.

However, MACs and QICs will still have the discretion to develop new issues and evidence for claims denied as a result of automated pre-payment review. MACs will also continue to follow existing procedures for adjusting claims after successful appeals, meaning CMS will process the adjustments and may suspend them because of system edits. Claim adjustments that remain unpaid because of additional system-imposed limitations (e.g., frequency limits or Correct Coding Initiative edits) may result in new denials with full appeal rights.

In addition, if a MAC or QIC conducts an appeal of a claim or line item that was denied on pre- or post-payment review because of insufficient documentation, the contractor will review all applicable coverage and payment requirements for the item or service at issue, which means the claim could subsequently be denied for lacking medical necessity. If you receive requests for additional documentation, please be careful to respond quickly and completely to prevent the possibility of expanded review of the whole claim.

Finally, CMS is applying the new guidance only to appeals received by a MAC or QIC on April 18 or later. Prior denials based on expanded evidence will not be reopened.

As noted, the CMS guidance provides some good news to physicians and other providers of Medicare services. But CMS has placed a number of limits on this guidance, and you will need to be aware of the phase and type of review (e.g., pre- or post-payment, automated or complex) to which a claim is subject and consider the possibility of subsequent system edits and denials when determining whether to appeal.   

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

Friday, June 24, 2016

Make sure to recertify EIDM users by June 30

Time is running out if your practice hasn’t recertified its user accounts in the Enterprise Identity Management (EIDM) system. Letting those accounts lapse could complicate reviewing your Quality and Resource Use Reports (QRURs) later.

Individual practitioners and providers’ security officials (SOs) have until June 30 to log into the system and recertify who in the practice has the right to access the system. The Centers for Medicare & Medicaid Services (CMS) requires users to recertify annually. Failure to recertify user roles will result in those roles being revoked. Once revoked, the user must go through the process of requesting the role from the SO or individual practitioner again.

The SO and individual practitioners can log into the CMS Enterprise Portal using existing credentials and access the list of users who require recertification. The list is located under the “View and Manage Access” page under the “Annual Certification” link on the left-hand side of the screen. If you experience issues, you can contact the QualityNet Help Desk at 1-866-288-8912. The QualityNet Help Desk can also tell you who the SOs are for your Tax Identification Number (TIN).

Maintaining access to the EIDM system is critical for the QRUR. CMS releases a mid-year QRUR and an annual QRUR. The 2015 mid-year reports were released in April, while the 2015 annual reports will be available in the fall. These reports provide information on a TIN’s performance on cost and quality measures. Practices can use the QRUR to review their performance and identify areas where improvement may be needed. Reviewing today will help practices prepare for the implantation of the Medicare Access and CHIP Reauthorization Act (MACRA).

– Erin Solis is the Regulatory Compliance Strategist at the American Academy of Family Physicians

Thursday, June 23, 2016

How much can you charge patients for their health information?

The Office for Civil Rights (OCR) within the U.S. Department of Health and Human Services recently addressed patients’ rights to access their protected health information (PHI) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Much of the guidance focuses on the fees that a covered entity, such as your practice, may charge patients requesting copies of their own PHI.

According to OCR, you can charge patients for:

1.    labor costs (including preparation of an explanation or summary when agreed to by the individual)
2.    supply costs related to the creation of either the electronic or paper copy (e.g., paper, toner, CD, or USB drive)
3.    postage costs when the individual requests the information be mailed

The OCR guidance indicates that permissible labor costs may include only the labor “for creating and delivering the electronic or paper copy in the form and format requested or agreed upon by the individual, once the PHI that is responsive to the request has been identified, retrieved, or collected, compiled and/or collated, and is ready to be copied.” (Emphasis added) That means you cannot charge for reviewing the request or searching for and retrieving the information.

The OCR also emphasizes that you may not charge individuals for system maintenance, data storage and maintenance, or the administrative costs associated with outsourcing your office’s response to requests for PHI. OCR further notes that if you use systems that allow individuals to access their PHI through electronic health record technology, you may not charge labor or supply costs.

The OCR guidance says that when calculating the fees you charge, they may reflect your actual costs, your average costs, or a flat fee. If using actual costs, they must be reasonable and calculated upon each request. OCR says that you can charge average costs as a standard rate (e.g., a per-page fee if you maintain the requested PHI in paper form and the individual requests a paper copy). The OCR adds that “per page fees are not permitted for paper or electronic copies of PHI maintained electronically.” Finally, you can charge a flat fee but only for electronic copies of electronically maintained PHI, and the flat fee cannot exceed $6.50.

Regardless of the fee method used, you must notify individuals in advance of any fees that could be charged for their requests for PHI at the time the details of the request are being arranged. Failure to provide such notice could potentially be a HIPAA violation.

If a patient requests that you send their PHI to a third party, you must treat that request the same under HIPAA as if the patient were requesting it be sent to them directly. However, if a third party initiates the request for PHI, the limitations on copying fees do not apply. So, you should ask whether the request was a direction from the patient or a request from a third party.

Finally, the OCR guidance discusses the relationship between HIPAA and state law. Specifically, when it comes to an individual's right to access his or her own PHI, HIPAA trumps state law if HIPAA provides individuals with greater access to their PHI. That means if your state law allows you to charge higher fees or to limit an individual’s access, HIPAA will preempt that state law.

Needless to say, now may be a good time to review your policies and procedures for granting access to individuals’ PHI, including whether and how you charge for copies of that information.

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

Tuesday, May 31, 2016

CMS releases list of approved 2016 PQRS registry vendors

The Centers for Medicare & Medicaid Services (CMS) has released the 2016 lists of approved Qualified Registries and Qualified Clinical Data Registries for the Physician Quality Reporting System (PQRS). Physicians and group practices may use these third-party vendors to submit quality measures for PQRS in 2016 and potentially avoid payment penalties associated with PQRS and the Medicare value-based payment modifier in 2018.

There are a number of other PQRS reporting options. For those new to the program, the AAFP provides a PQRS overview, and CMS has instructions on how to get started.

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

Tuesday, May 17, 2016

Small practices face potential headaches under MACRA

For solo and small physician practices, the recently published proposed rule for how the Centers for Medicare & Medicaid Services (CMS) plans to implement the Medicare and Children’s Health Insurance Program Reauthorization Act (MACRA) set off some alarm bells. According to the proposed rule’s regulatory impact analysis, 87 percent of solo practice clinicians who are eligible for the Merit-Based Incentive Payment System (MIPS) – one of two payment tracks under MACRA – will receive a penalty; for groups of two to nine clinicians, the percentage is almost 70 percent.

Responding to the concerns generated by this analysis, CMS has now issued a fact sheet that attempts to show it is sensitive to the unique challenges that small practices face in different types of communities. The fact sheet is also meant to show that the agency’s proposed implementation of MACRA, including MIPS and alternative payment models (APMs), provides accommodations for various practice sizes and configurations. Among the provisions that CMS highlights in its defense are:

• Clinicians or groups that have $10,000 or less in Medicare charges and 100 Medicare patients or fewer are excluded from the MIPS payment adjustment.
• When a practice is scored for MIPS, it will only be scored for categories where it has a sufficient number of applicable measures and activities.
• Small groups will have more flexibility within each of the MIPS performance categories. For example, CMS will calculate only two population measures based on claims data for solo physicians and groups of nine or fewer physicians instead of the three population measures required for larger groups under the quality performance category of MIPS.

CMS also notes that the proposed rule allows small practices or practices in rural or healthcare professional shortage areas to participate in the Advanced APM track – and receive incentive payments – by providing special rules for these practices to qualify as Advanced APMs under medical home models.  

Ironically, CMS plans to delay implementing one provision of MACRA specifically intended to help solo and small group practices succeed under MIPS. Specifically, MACRA allows MIPS-eligible professionals to combine into “virtual” groups to participate in the payment track. However, as noted in the fact sheet and the proposed rule, CMS will not make this option available until the second year of the program.

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

Friday, May 13, 2016

Medicare physician use and payment data for 2014 now available

The Centers for Medicare & Medicaid Services (CMS) has released its annual report on Medicare physician utilization and payment data.

Covering calendar year 2014, the public file lists Medicare Part B payments and submitted charges for more than 986,000 individual physicians and other health care providers who collectively received around $91 billion. By comparison, the report for 2013 included $90 billion in payments to 950,000 physicians and other providers.  

The latest report uses Medicare standardized payment amounts, which adjusts for geographic differences to make payments to physicians in different parts of the country comparable.

As we’ve discussed in the past, these annual payment reports show not only the range and complexity of care that family physicians provide but also the variation in reimbursement among medical specialists. For example, family physicians received an average of $61,804 in total Medicare payments during 2014. By comparison, internists received an average of $92,760 and cardiologists received an average of $222,373. As in the past, physicians weren't given an opportunity to review the information tied to their names for errors and the amounts don't reflect risk-adjustment, Medicare not covering the full cost of certain treatments, or other factors.

As CMS moves to tie physician reimbursement more closely to value, presenting accurate individual physician payment and utilization data to patients and other interested parties will become more critical.

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