Ancillary procedure payments cut under 2018 CMS Physician Fee Schedule — 5 insights

Anesthesia Business Consultants President and CEO Tony Mira penned a blog post on how the 2018 CMS Physician Fee Schedule will impact ancillary procedure payments and what anesthesia groups should do in response.

Here's what you should know:

1. The Physician Fee Schedule will significantly reduce work value concerning flat-fee ancillary services.

2. Mr. Mira suggests anesthesia groups review collection percentages to determine how much income comes from the soon-to-be affected flat-fee services. The Physician Fee Schedule will go into effect Jan. 1, 2018.

3. CMS changed several Relative Value Units concerning anesthesia procedures. The first change concerned non-tunneled centrally inserted central venous catheter in patients age 5 and older, which CMS viewed as misvalued. While reviewing it, CMS identified three other codes that were misvalued.

They are:

  • Insertion of a non-tunneled centrally inserted central venous catheter, younger than 5 years;
  • Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure)
  • Percutaneous and insertion and placement of a flow directed catheter for monitoring.

After reviewing the codes, CMS reduced reimbursement for all four in its final rule.

4. Mr. Mira writes that although reimbursement for flat-fee services was stable for some time, "we've seen clouds on the horizon in the form of fee erosion in some commonly performed services."

5. Mr. Mira said anesthesia reimbursement is being reduced by the erosion in work value used to calculate payment rates and through the bundling of services.

He said, "For the past five years, the fastest growing service line for virtually every practice of which we are aware has been the use of blocks in pain management. These earlier changes and the current ones for certain flat-fee services are a double-whammy that has anesthesia groups concerned."

For more information, click here.

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