Part B Insider (Multispecialty) Coding Alert

Published on Sat Aug 27, 2005 PDF

Medicare pay cut more likely in the wake of Katrina and Rita

Do you want to take a pay cut of nearly 5 percent next year, and maybe the next few years after that?

If not, then it's time to get busy. The Centers for Medicare & Medicaid Services is still predicting a drop of 4.3 percent in your Medicare payments next year, and the chances of avoiding this disaster have gotten slimmer. With the costs of cleaning up after Hurricanes Katrina and Rita mounting up, Congress is looking to cut Medicare--not add money to it.

Capitol Hill insiders tell PBI that the Katrina aftermath has pushed back the schedule for dealing with everything, including next year's budget. Members of Congress are very aware that physicians are facing a steep cut next year, and "there's even a lot of sympathy," but it may not be possible to solve the problem with the high costs of Katrina, says one Hill insider.

Opportunity: Now is the time to call your Representative or Senator and make the case for saving Medicare patients from cuts, say insiders. If you pass on the message that Medicare patients will lose access to care if physicians lose out, then Congress is ready to listen, says attorney Rebecca Burke with Powers Pyles Sutter & Verville in Washington.

Snag: The only problem is that thousands of people in the Gulf states are already having problems finding doctors, say Hill insiders. Congress is worried about patients' immediate access to physicians, so it's harder to convince legislators to focus on access problems that might hit next year.

"If you're a member of the Louisiana delegation and you're wondering if you're going to have any doctors in the lower half of the state, that takes precedence," says one insider.

The bottom line: That just means you have to try even harder to make your voice heard.

Some observers are more optimistic. "Certainly the competing needs for funds don't make it any easier," says Rich Trachtman, director of congressional affairs with the American College of Physicians. "But I don't think that Congress has lost sight of the need to address the physician fee schedule cut."

Help May Be On The Way

CMS may finally remove Part B drugs from the formula it uses to calculate updates to your reimbursement, say insiders. If CMS makes this change retroactively, then your payments might only be cut half as much. And it would be less expensive for Congress to avoid cuts completely.