• Helping compare Medicare costs and copayments gets easier

    The Centers for Medicare & Medicaid Services (CMS) has launched a new online tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers. The Procedure Price Lookup tool displays national averages for the amount that Medicare pays the hospital or ambulatory surgical center (ASC) and the national average copay for a beneficiary with no Medicare supplemental insurance.

    What does this have to do with getting paid in your practice? Many physicians are now subject to Medicare’s Merit-based Incentive Payment System (MIPS). One of the elements that affects your final score under MIPS (and thus your Medicare payments two years down the road) is how much the care you provide to your Medicare patients costs, including procedures done in the hospital or ASC. That cost can come back to bite you as it now directly affects how you get paid under Medicare.

    Medicare’s statutes require CMS to maintain separate payment systems for different types of health care providers, meaning both CMS and patients may pay different amounts for the same service, depending on the site of care. The Procedure Price Lookup tool will help you and your Medicare patients consider cost differences when choosing where to refer or send a patient for a necessary medical procedure. Of course, cost of care is just one factor to consider when looking for referral options. Quality, for example, is another.

    The Procedure Price Lookup tool also helps you talk with your Medicare patients about the cost of their care, something most Americans say they want to discuss with their health care providers but only a small percent report doing. Research indicates almost all patients have concerns about costs but often wait for their physician or other health care provider to initiate the conversation. Cost-of-care conversations do not necessarily add a significant amount of time to medical visits, often less than a minute. That minute can pay dividends to the practice down the road when you receive your final MIPS score.
    This effort is part of CMS’s eMedicare initiative, which includes other patient-oriented transparency tools, including CMS’s drug pricing and spending dashboards. CMS recently launched the eMedicare initiative to empower beneficiaries with cost and quality information. Online resources are also available to help physicians and others with their side of the cost-of-care conversations.

    – Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians

    Posted on Nov 30, 2018 by Kent Moore

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.