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Deleting Medicare Consult Code Could Hurt Patients, Say Doctors

Cheryl Clark, for HealthLeaders Media, December 4, 2009

A Medicare rule that will eliminate specialist physicians' ability to bill higher amounts for patient consults as of Jan. 1 "has caused a combination of panic and confusion" and should be postponed for a year, the American Medical Association wrote in a lengthy letter.

"Without such a delay, we anticipate payment denials, re-submissions and appeals that could create claims backlogs, cash flow problems and increased costs that could lead some physician to avoid Medicare patients," wrote Michael D. Maves, MD, AMA executive vice president, in a Nov. 25 letter to Jon Blum, director of the Center for Medicare Management of the Centers for Medicare and Medicaid Services.

The impact will be even worse "if Congress has not acted to prevent a scheduled 21.2% cut in the conversion factor that is scheduled to take effect on Jan. 1," he wrote.

Maves wrote that without a delay to educate doctors and consider the implications of the change, "two potential unintended consequences" will occur.

"First consulting physicians may stop accepting Medicare patients referred for consults. Second, more and more consultants may stop interpreting the findings in the medical record in a report back to the referring physician.

"Each scenario presents significant care coordination concerns and while CMS says it will be on the lookout for any unintended impact the new policy could have on care coordination, some real damage to individual patients could occur while CMS is still in monitoring mode."

Maves told Blum that "physicians will experience claims denials, audits and repayment demands, and conflicts with secondary payers simply for following the rules that CMS has laid out. Increased frustration and costs for physicians, payers and patients seem sure to follow."

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