Gastroenterology Coding Alert

Good News: Chronic care non-face-to-face services might yield bonuses in 2015.

While the proposed 2014 Medicare Physician Fee Schedule outlines possible changes to policies and payment rates for services rendered on and after Jan. 1, 2014, your gastroenterology practice might take a hit as Centers for Medicare & Medicaid Services (CMS) will be making across-the-board payment cuts via the conversion factor.

The better news is that CMS has suggested an innovative new approach to handling patients with chronic issues by proposing primary care bonuses for following patients with two or more chronic conditions; this change could take effect in 2015.

Prepare for a Conversion Factor Plunge

CMS noted in the proposed rule that the confirmed conversion factor won’t be released until the Physician Fee Schedule Final Rule is published this fall. However, based on current calculations, the conversion factor for 2014 is estimated to be $26.7109, which reflects a 21 percent cut from the current conversion factor of $34.0320.

Silver lining: In prior years, Congress has always voted to increase the conversion factor so that physicians don’t face such steep cuts, but this means that 2014 will once again present the requirement to face a waiting game regarding pay.

“It was hoped that the SGR formula which has created these annual last minute Congressional actions to forestall a large payment cut would finally be fixed this year,” says Michael Weinstein, MD, Gastroenterologist at Capital Digestive Care in Washington, D.C., and former representative of the AMA’s CPT® Advisory Panel. “If it is removed, then it is likely physicians will see a prolonged pay freeze with additional requirements for PQRS reporting and maybe a Patient Centered Medical Home bonus for primary care physicians.A number of specialist societies are lobbying to allow their members to be Medical Homes for patients whose primary condition is managed by a specialist along with other routine medical care needs.”