How the “Flat-Rate” Medicare Proposal will level off physician income! (Proposed Fee Schedule 2019)

Hello, this is Dr. Lakowsky with Reimbursement Rx again, and I just want to go over a question we received, lots of questions recently about this new Medicare proposal to level off levels of service and pay doctors one rate. As we mentioned, that it wasn’t really good for physicians and we’ve been asked why. For those of you who are just coming out of training, you may not be familiar with how things work. Here’s a very brief, quick and dirty rundown. In the office setting, you are probably going to use four levels of service. From 99212 to 99215 and those are the established patients. There’s also codes for new patients, but we’re just going to focus on established patients right now. There’s 99211, which is a nurses visit, which doctors don’t use and levels from 2, 3, 4, to 5. The higher you go, the more complex the patient is. Sometimes there’s a time attached to it, but you don’t have to use the time, you need to use certain components of E and M codes, and E and M components, documentation requirements, and we can talk about it later in greater detail. Right now it is important for you to know that when you see a very easy in-and-out patient, that is usually a level two. When you see tiny more complicated patient with a very stable medical problem, it’s going to be level three. The vast majority of your visits are level four and five, depending on your practice setting. Let’s say you are a cardiologist and you deal with heart failure, and arrhythmia. So let’s say you are an endocrinologist and you’re dealing with diabetes, and hypothyroid is more, if you’re a primary care doctor, you deal with it all. So of course your typical patient will have at least three or four issues. They are going to be on three or four medications and it takes time, and it takes effort to make sure that they are being well taken care of. You know what you do to them in the office, you just helping them manage their chronic disease. And those are almost always going to be Level 5 or Level 4 visits. And for Level 4, Level 5 visits, of course you’re getting paid more than for Level 2 and Level 3 How much you get paid for Medicare? Well, it’s very dependent upon your geography. Depending upon where you are in the country. But it’s very easy for you to look up nationwide averages, and the average for Level 3, 99213 reimbursement is probably around $90 And level four is around mid, $100, $110, something like that. Level five is closer to $120, now the proposal is that you are going to be paid a flat rate, regardless of how complex your patient is. So for instance, you see a heart failure patient with diabetes and atrial fibrillation. It’s going to be a flat rate of $93. Let’s say somebody comes to you with earache, it takes you two minutes, it will be still $93. Which will probably be a little bit more than your previous code of 99212 and 99213, but complex patients, that’s what we do, that’s what all doctors do. And complex patients, by far overweigh those easy ones. And what this new proposal will do, because commercial insurances will follow Medicare’s lead. What that will do s greatly decrease your reimbursement. which is why it’s very important for you to understand, especially you younger doctors just coming out of training as to how this is going to affect your practice, your income, and your overall reimbursement. Thank you for watching.

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