Lawmakers urge CMS to abandon proposed Medicare billing change

Lawmakers want the CMS to abandon proposed changes to Medicare billing codes they fear will lead to doctors being underpaid.

"We are concerned that the proposal to consolidate these services devalues the expertise, clinical decision-making, and time of physicians who treat patients with complex conditions," a bipartisan group of 90 lawmakers wrote in a letter sent to the CMS on Friday.

Lawmakers wrote in the letter that the CMS did not adequately reach out to stakeholders before the proposal went public. Lawmakers want the agency to collaborate with providers to identify new ways to accomplish the CMS' goals while ensuring that physicians are reimbursed appropriately.

The CMS proposed the change earlier this year as part of its initiative to reduce the administrative burden for clinicians.

The agency predicts the proposal will save about 51 hours of clinic time per clinician every year.

Most providers will see payment fall or increase by only around 1% to 2%. The CMS estimated that cardiologists, oncologists and neurologists would see a 3% cut. Rheumatologists would receive a 6% cut and endocrinologists an 8% cut if the rule was finalized.

Major health systems echoed lawmakers' concerns in comment letters posted Monday, the final day to provide comment. System executives worried that patients with the most complicated health conditions could suffer.

"The proposal could incentivize physicians to ask the patient to return for another service visit rather than risk a reduction in reimbursement," Dr. Richard Shannon, executive vice president for health affairs at the University of Virginia Medical Center wrote in a comment letter. "This would not only inconvenience the patient, but it could increase patient wait times for appointments for both Medicare beneficiaries who seek a new doctor as well as those who wish to see their current physician."

A CMS spokesperson confirmed receipt of the letter and said the agency plans to issue a response. She added that the agency has extensively sought input from stakeholders.

Most physicians bill Medicare for patient visits under a relatively generic set of codes that distinguish the level of complexity and site of care, known as evaluation and management visit codes. The system has been in place since 1995.

The agency proposed a new payment structure that collapses the level 2 through level 5 office codes into single blended payment rates for new and established patients.