PHYSICIANS MAY have gained a small reprieve with the passage of the Medicare Improvements for Patients and Providers Act in July. The bill, if it remains veto-proof as expected, would halt the 10.6 percent reimbursement cuts that had been slated for July 1 and provide a 1.1 percent increase in 2009.
Despite the so-called Medicare “fix,” experts say that without a fundamental alteration in the way this country pays physicians for Medicare services, access to care may be compromised as physicians choose to drop the program. This and a host of other concerns currently plague physicians' bottom lines.
Medicare billing enforcement activity is expected to increase sharply. The federal government completed a three-year pilot of the Recovery Audit Contractors (RAC) project this spring in several parts of the country and issued its final report in June. According to the Department of Health and Human Services, the program corrected more than $1.03 billion in Medicare improper payments.
The government now plans to expand the program, and experts like Michael Miscoe, a certified professional coder, predict the feds will have “a field day” when the nationwide crackdown begins.
This isn't the only nightmare ahead for providers. Within the next few years, Medicare billing will be moved from the ICD-9 to the ICD-10 system, a transition that experts predict could cost small physician practices as much as $70,000 in preparation, technology purchases and training for physicians and staff.
A survey of more than 400 doctors, conducted in June by the Association of American Physicians and Surgeons, found 81 percent don’t use electronic health records and most have concerns about federal interference in the way they practice medicine. Many respondents said they would rather retire in their 50s than adopt EHRs. Other concerns included doubts about return on investment and lack of capital to invest in healthcare IT.
After a year-long contingency period, the use of National Provider Identifiers was required by the government on May 23 for physicians participating in Medicare. Since that time, doctors have had difficulty getting paid due to a host of glitches in the government and clearinghouse systems, experts say.
According to Cyndee Weston, executive director of the American Medical Billing Association, many doctors who began using NPIs before the May deadline have not received Medicare reimbursements for months.
“I think we haven't seen the worst of this yet,” she said.
With the difficulty in defending a fair increase in pay and difficulties in billing Medicare, it's a wonder more doctors don't want to retire early or drop Medicare patients.