Until December 31, 2009 the cardiologist could charge a “physician consult” fee for getting out of bed, coming to the hospital, and evaluating a patient with a potentially life threatening problem. Medicare paid $195.76 for this middle-of-the-night work (the same rate as when done during the day).For patients, the changes are already being felt. As of 1 January 2010 the lead dog, Mayo Family Clinic in Glendale Arizona, no longer accepts Medicare patients.
By eliminating the “physician consult” billing code, Medicare now advises the specialist to charge for a “hospital admission.” For two more months, Medicare will pay $175.67 for this service. However, without a change in current law, the physician’s reimbursement for a “hospital admission” will drop to $141.63 on March 1. This is why the “Doc Fix” is so important for working physicians and their Medicare patients.
Other recent and obscure changes in Medicare guidelines are potentially even worse.
As of January 1, Medicare will not pay the consultant at all unless the admitting physician uses an “HI modifier” when billing Medicare for the initial admission. This means in order to get paid, the consulting physician must rely on another physician’s billing practice. Many physicians remain unaware of this obscure change (Medicare guidelines were altered as recently as December 17). The result? Many consultants will be denied payment altogether—yet another way to “save” Medicare dollars.
I'd be interested to know, how do you envision the current physician payment changes underway affecting your practice?