Medicare Compliance & Reimbursement

You could receive pay boosts of up to 3-percent per year.

If you took away all the mistakes that the Centers for Medicare & Medicaid Services (CMS) had made over the years in calculating the annual updates to physician payment rates, you would still be in for a cut of around 2.4-percent to 4-percent per year, says one influential body.

But if the feds based each year's update only on comparing last year's spending with a target, you could receive an annual pay boost of up to 3 percent, according to a presentation at the Medicare Payment Advisory Commission's (MedPAC) Oct. 9 meeting.

The commissioners considered options that would allow for small cuts, or updates that just ranged from 0 percent to a measure of inflation. MedPAC has until next March to report to Congress on options for reforming the current system, which results in steep cuts every year.
 
Meanwhile, drug wholesalers may be receiving bulk discounts on Part B drugs that they don't pass on to physicians, MedPAC commissioners said. Those discounts could have the effect of slashing the amount CMS pays for your drugs.
 
Also, CMS doesn't account properly for the difference between the amount your wholesalers pay and what the wholesalers charge you, the commissioners speculated.

The sharp cuts in drug payments have forced many patients to receive drugs in the hospital instead of the doctor's office, MedPAC staff said.

Also, MedPAC criticizes CMS for sticking with this year's 25-percent reduction on payments for imaging scans on contiguous body parts, instead of going up to a 50-percent reduction, as CMS had originally planned. In its written comments on the physician fee-schedule proposed rule, MedPAC supports CMS' policies restricting "condo labs" or "pod labs."