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Docs, Specialists ID Proposed Payment Fee Concerns

Cheryl Clark, for HealthLeaders Media, July 15, 2014

Specialists' Concerns
Also high on the list of concerns over CMS's proposed fee changes are cuts in payments for certain common codes used for colonoscopy and upper endoscopy procedures by gastroenterologists and other specialists, says Colleen M. Schmitt, MD, president of the American Society for Gastrointestinal Endoscopy.

In the proposed 2014 rule issued this time a year ago, CMS had very few reduced payment changes, but in the final rule, dozens of common procedures were cut as much as 30%.

"We're concerned this year that the same thing could happen, especially for colonoscopy, without an opportunity for us to participate in feedback with CMS about the changes they're making," says Schmitt.

"Keep in mind that many of the practices in the U.S. are small groups. They're essentially small businesses, and they have responsibilities to employees. And adjustments like this they have to make quickly have significant ramifications."

CMS also is proposing to do away with the current ability of anesthesiologists to bill CMS separately for sedation services during colonoscopies, and instead cover the entire service as a bundle. That way, patients won't be billed twice for separate Part B co-payments, one for the gastroenterologist and another for the anesthesiologist.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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