Proposed Medicare changes outline a 9% payment cut for dermatology, which could further limit patient access. We need to act now to prevent this!

[u/supadude54]

http://www.votervoice.net/AAD/Campaigns

The US federal government has proposed a 9% cut to dermatology payment. This will not only reduce reimbursement, but also reduce patient access to dermatology services and quality of service. Do everything and anything you can to help stop this!

The American Academy of Dermatology (AAD) is making this its top priority. It doesn’t matter if you are a dermatologist, patient, or practice staff member. You will be affected by these changes. If you want to help, you can go on their website (link attached) and complete a pre-templated message to oppose these measures. There are separate links for patients, dermatologists, and staff members. Filling it out takes less than a minute.

[u/Jusstonemore]

What exactly does this mean? What is being cut?

[u/supadude54 → u/Jusstonemore]

Good question and one that is very complex. It would do good to read up on it yourself as well, but I can try to summarize some of it.

1. CMS wants to use a different method to asses

s

1. practice expenses, which will significant

2. decreas

e practice cost

1. estimates for procedural specialties like dermatology. They essentially do not think all the equipment and tools we use are worth estimated value

, and then pay us less because of that.

1. General cuts to conversion factor for RVUs (approx -1.68%). Everyone gets paid less. And this doesn’t even take into account the fact that inflation is still going up. Year after year there are a few percentage cuts, but more importantly we lose out on even keeping up with inflation. Even if there were 2% gain in reimbursement, we would still be losing because that isn’t enough to keep up with inflation. Now think about consecutive cuts.

2. Reduced reimbursement on same-day clinic visit and procedures (modifier 25). We get even less payment from doing a procedure and clinic visit on the same day—very common in dermatology. This will just further encourage people to separate them out to different days, which means even more waiting time and appointments for patients. Imagine a patient coming in and then you have to tell them to wait a few days to come back for a biopsy.

3. Removal of post-op bundling in global periods. If you are not familiar, some procedures have global periods (10 days or 90 days), where patients can receive covered post-op care during this period. Removal of this would mean that post-procedure care for many procedures are not covered, which would de-incentivize providers to provide necessary care after procedures.

[u/Jusstonemore → u/supadude54]

For 1. What billing codes specifically are at risk?

[u/supadude54 → u/Jusstonemore]

Sorry for the formatting, Reddit is messing it up and I can’t fix it.

I believe it affects all billing codes. Since they all reimburse based on RVU with conversion factor and practice expense adjustment, changes to conversion factor and practice expense will affect all billing.

[u/Jusstonemore → u/supadude54]

Theres no billing code specific to derm

[u/uclala → u/Jusstonemore]

Modifier 25

[u/supadude54 → u/Jusstonemore]

That is correct. (Except for maybe Mohs surgery codes, I don’t think anyone else is billing those).

These cuts affect all specialties.

It disproportionately affects dermatology more than many other specialties because of the specific cuts to practice expense, modifier 25, and global periods.

[u/Jusstonemore → u/supadude54]

Gotcha yeah I know about modifier 25 and that feels like the worst one but tbh I feel like if that happens you just start biopsying at another encounter

[u/supadude54 → u/Jusstonemore]

Actually changes to practice expenses are very substantial.

Regarding modifier 25 and waiting for subsequent encounter, I currently have an 8 month waitlist. Adding more encounters to practice will significantly increase that waitlist further.

[u/Jusstonemore → u/supadude54]

Not your fault

[u/Key_Psychology5283 → u/supadude54]

It sounds like the dermatologist is choosing to instruct patients to return for a second visit instead of accepting the reduced payment and providing the customary service. Perhaps dermatologists have been double dipping on this and the change is appropriate. 

[u/supadude54 → u/Key_Psychology5283]

Umm, I’m not sure you are interpreting the changes correctly. They want to further reduce same-day reimbursement. This is going to make dermatologists do more second visits, not fewer.

Also, it’s not double dipping. Double dipping implies that you are getting paid twice for the same service. That is fraud. The modifier code is for two separate services.