NP Business™ Tip: Medicare 2010: How Will It Affect Your Practice?

There has been a lot speculation and many questions about what to expect from Medicare for 2010. If you or your practice accepts Medicare payment for "physician" services (this includes NPs, CNS and PAs), you must pay attention to this. Even if you are employed, you need to be aware of how this will affect your employer, and possibly your position.

Reduction in Payment. Medicare has been set to reduce payment for services by 21.2% across the board as of January 1, 2010. Recently that cut was pushed back to March 1, 2010. In the past, cuts have usually been stopped at the 11th hour; however, those cuts were much, much smaller. 21.2% is the largest figure I've seen proposed in years. With the current situation, we just don't know what to expect.

Secondly, the consultation codes (CPT codes 99241-99255) have been eliminated and will no longer be reimbursed. As of January 1, 2010, you will use the standard office visit codes (99201-99215) for consultation.

I would recommend that each of you go to your Medicare intermediary and download the fee schedules. Make sure you check the dates on the schedules to make sure they are the most up to date copy you can receive. You'll find the list of fiscal intermediaries here (this is a PDF file).

Now…all of this is still up in the air. It seems every year there is a proposed cut that gets delayed. And while there are several organizations working on this issue, I think this year is a bit different given the economic climate. Additionally, we don't yet know (as of this writing) what is going to come out of Congress regarding health care reform and how it might affect the Medicare Program.

Best advice - stay tuned and be prepared.

NPBO™ Action Steps: It is imperative that you are aware how these potential cuts will affect your practice. Here is a list of things you can do:

• First, know your reimbursements. Go you your Medicare intermediary and download the new fee schedule. Remember, that as NPs and PAs, we only receive 85% of the physician allowable. Further, you'll need to calculate 80% of that 85% as some carriers and patients will not pay that additional 20% (notably in individuals with Medicaid as secondary).
• Calculate how many of your clients are on Medicare. How many of these folks do you see in a month? What is the bottom line difference this will make in your practice?
• Insure that your billing is up to date and that you are being paid for all covered services you provide.
• Follow up on patients regarding their deductibles and co payments/co-insurance. If you don't already, consider collecting co-pays up front to reduce your potential loss.
• Review your payor mix. Do you need to revamp your marketing in order to increase your case load of folks with commercial insurance?
• Explore new ways to generate income.

While we can sometimes feel powerless when Medicare makes changes like this, we can decide how we will respond, both on a political level and a practice level. Being prepared and knowing how this impacts you is the first step.