Docs, Specialists ID Proposed Payment Fee Concerns

Cheryl Clark, July 15, 2014

Representatives of several physician groups say a monthly payment for managing patients' chronic conditions is the most significant provision of CMS's proposed 2015 Physician Fee Schedule.

Physician reimbursement for currently unpaid time spent dispensing non-face-to-face care, an expanded payment modifier, and cuts for some common codes used by specialists are among the provisions in Medicare's Physician Fee Schedule proposal getting attention from physicians groups.


Reid Blackwelder, MD,
President, AAFP

The Centers for Medicare & Medicaid Services' 609-page proposal released July 3 outlines how doctors will be paid starting Jan. 1, 2015.

While representatives of several physician groups interviewed last week said they were still reviewing the proposed rule, there was general consensus that the G-code monthly payment is the document's most significant provision.

Though it was contained in the 2014 final Physician Fee Schedule issued last November, an actual G-code amount—$41.92 per beneficiary—was not proposed until now.

Primary care physicians, for the first time, would be paid for taking care of Medicare beneficiaries with two or more chronic conditions without providing a face-to-face patient encounter. That could mean coordinating care provided by specialists; managing lab and imaging reports, medications and care plans; and talking with families and patients on the phone.

These are tasks physicians commonly provide, but for which they are not specifically paid.

"We're certainly pleased there's a step in the direction of recognizing the care we provide," says Reid Blackwelder, MD, president of the American Academy of Family Practitioners. "Our Medicare patients are getting more and more complicated and complex, and 60% will have four or more chronic conditions."


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