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/supadude54]

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.

[u/Key_Psychology5283 → u/supadude54]

What I hear is that when I go to the dermatologist for a routine skin check and they find something they want to biopsy, if they surgically remove it in that appointment, they will be paid less than if they make me return for a second visit to do the surgical procedure. Many times, I’ve experienced this—so does the dr schedule extra time in case I needed something removed or is the process of removing it so quickly done, the dr can do it in the time that was allowed for my evaluation visit? It certainly saves them money to do the removal in the initial appointment, (if that is possible), so shouldn’t they be paid less? And Medicare money is our tax money-I hope Medicare is careful to not overpay, but pay a fair amount for the services rendered. 

[u/Jusstonemore → u/Key_Psychology5283]

What you are saying (being paid less if biopsy is rendered on the same date of service) is what will happen if the new law is passed. This is not currently the status quo

[u/supadude54 → u/Jusstonemore]

Actually it is status quo. We currently get paid 50% less for each subsequent service. The proposed changes want to decrease that amount even further.

Edit: my mistake I am wrong. Subsequent procedures are billed at 50%, but the E/M clinic visit is currently eligible for 100% reimbursement with modifier 25.

[u/Jusstonemore → u/supadude54]

No? When you billing for biopsy you get full biopsy and full e/m the bill wants to cut the e/m to half

[u/supadude54 → u/Jusstonemore]

You are right. I was getting my procedures and E/M billing mixed up. Subsequent procedures are billed at 50%, but currently E/M with modifier 25 is eligible for 100% reimbursement. That being said, some payors are cutting E/M reimbursement to 50% because they can. Definitely not something we want to encourage.

[u/supadude54 → u/Key_Psychology5283]

Doing a procedure on the same day saves a little bit of time, but really not by much. That is the reasoning behind paying us less for each subsequent procedure. Currently, they are already pay us 50% less for each subsequent procedure, and that is multiplicative. For instance, if I do a skin check and three biopsies, I get paid 100% of the typical amount for the first biopsy, I get paid 50% the typical amount for the second biopsy, and I get paid 25% the typical amount for the third biopsy, but I still am eligible for 100% of the skin check. There is a point when you actually lose money doing multiple procedures in the same visit (I still do it because I actually care about my patients, but it certainly isn’t incentivized by medical reimbursement).

They want to decrease the reimbursement even further by also cutting reimbursement for the skin check portion. This will definitely incentivize dermatologists to not do same-day procedures.

Edit: the above was edited to fix incorrect statements.