Medicare Compliance & Reimbursement

Level 3 office visit reimbursement not enough for difficult service, physicians complain.

Far from being a boon to doctors, the new "Welcome to Medicare" exam benefit will be a huge and underfunded burden, doctors complained at the Aug. 30 Practicing Physicians Advisory Council meeting.

In the proposed rule for the 2005 physician fee schedule, the Centers for Medicare & Medicaid Services said it would pay for the equivalent of a level three new patient visit (99203) plus an electrocardiogram (93000) for the one-time service, to be covered within six months of a beneficiary's joining Medicare. CMS also included several pages of description of the kind of services and counseling a physician would be expected to provide.

The services include assessing the patient's possible depression, developing a care plan for any chronic illnesses and scheduling immunizations. The welcome exam aims to bring new Medicare patients into the system and set up a plan of preventive care.

Most primary care doctors will say, "I hope somebody else does the 'Welcome to Medicare' visit, because I don't want to spend an hour of my time, which is what I think it would take at a minimum, and get paid a level-three visit," one doctor told the PPAC meeting. Doctors asked CMS to reduce the level of detail in its requirements for the benefit. With a million patients entering Medicare every year, this requirement adds a million hours to doctors' workload.

Another doctor described the requirement as "the E&M coding guidelines gone wild."