JACKSON, Mich.--(BUSINESS WIRE)-- There is lots of activity in the world of anesthesia at the moment. Anesthesia Business Consultants would like to further clarify the somewhat confusing eRx Penalty and Hardship Exemption program and discuss a new MedPAC alternative to the SGR.
eRx PENALTIES AND HARDSHIP EXEMPTION PROGRAM
Most anesthesiologists will not qualify for either the eRx bonus or the eRx penalty because they submit very few electronic prescriptions and report very few of the outpatient visits encompassed by the eRx measure.
What this means to you: Anesthesiologists are not subject to any eRx penalty this year if they did not:
- Submit claims to Medicare for at least 100 outpatient or office visits, for dates of service between January 1, 2011 and June 30, 2011. Only those evaluation and management services identified by one of the CPT™ codes in the measure specification (including codes 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214 and 99215) are counted, and
- At least ten percent of the individual physician’s Medicare allowed payments come from evaluation and management codes that are in the measure specification.
Very few anesthesiologists will satisfy this two-part test, unless they also provide pain medicine services in the outpatient or office setting. Once they have determined that they did not perform enough visit services to be liable for the penalty, providers do not need to do anything further. In particular, they do not need to apply for an exemption from the penalty.
Individual providers who need an exemption – and if there is any doubt, we recommend requesting all the exemptions that apply – must do so personally at http://www.qualitynet.org/pqrs. Administrative staff cannot do this on behalf of their physicians.
MEDPAC PROPOSES AN ALTERNATIVE TO THE SGR
The Medicare Payment Advisory Commission (MedPAC) last week released new draft recommendations dealing with the Sustainable Growth Rate (SGR) problem, i.e., the GDP-based formula that has been driving payments to physicians down for more than a decade. MedPAC proposes that Congress repeal the SGR, whose flaws it has pointed out many times, and adopt an alternative method of updating Physician Fee Schedule payments The Commission will vote on the proposal at its regular meeting on October 6-7, 2011.
If the SGR is not repealed, Medicare payments to physicians will drop by about 30% on January 1, 2012.
If the SGR is repealed and the MedPAC alternative is adopted by Congress, payments to primary care physicians would be frozen for 10 years, while payments to specialists, including anesthesiologists, would drop by 17% over the three year period 2012-2014 and then would be frozen through 2021.
Either scenario would place a huge burden on physicians who serve Medicare patients. Anesthesiology services would be paid at around 2% less than in 1991, 20 years ago, under the MedPAC alternative. If the SGR 30% reduction goes into effect, next year’s payments to anesthesiologists will be about one-quarter lower than they were in 1991. Primary care and surgery would fare better than anesthesia because of technical issues in the way that Medicare has calculated the rates for each group.
Organized medicine quickly denounced the MedPAC proposal while continuing to lobby for a Medicare payment update system that does not roll back payment levels. ABC strongly supports the efforts of the American Society of Anesthesiologists.
For full details on these new developments, please see our Alert on the matter: http://www.anesthesiallc.com/publications/ealerts/278-federal-budget-proposals-and-medicare-payments-for-anesthesia-services
About Anesthesia Business Consultants
ABC, established in 1979, is one of the largest billing and practice management companies dedicated to the complex and intricate specialty of anesthesia and pain management. It is both an American Society of Anesthesiologists Practice Management Supporter, and an Anesthesia Quality Institute Preferred Vendor. ABC employs industry leaders, operates under proven efficient processes, and utilizes technology advances to easily adapt to the ever-changing regulatory environment.
If you would like more information about this topic, please go to [email protected].
CONTACT:
Anesthesia Business Consultants
Tony Mira, 517-787-6440
[email protected]
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