President Donald Trump and his administration are working to lower Medicare costs by ending a double-billing process targeting seniors. The rule, set to take effect in January, is expected to significantly reduce Medicare costs by changing the way physicians charge patients for same-day exams and services.
Currently, doctors can charge Medicare recipients twice for exams during same-day services. The exam fee is called an “evaluation and management fee” and can cost more than $235.
For example, during a Medicare recipient’s standard dermatology exam, the doctor can charge the recipient twice for an exam of a mole if the removal service is performed on the same day. This is a common form of Medicare double billing among health care providers.
In a recent audit by the Department of Health and Human Services, the Office of the Inspector General found that 42% of Medicare beneficiaries were double billed for intravitreal injections during eye exams, a recurring procedure. The same-day exam and procedure allowed the claims to bypass the system designed to prevent improper payments.
California and Florida are the top two states, with roughly 10 million Medicare beneficiaries combined, to benefit from this rule change. It is expected to take effect in January, just after the midterm election.
The proposed rule was announced in July and was open for public comment through mid-September. Now, the Centers for Medicare & Medicaid Services is evaluating the public comments and will soon announce the finalized rule.
The proposed rule suggested cutting the initial exam fee to 50% from 100% and keeping the final exam and procedure fee at the standard 100% charge. While the Trump administration has supported the rule change, Medicare providers and beneficiary associations have opposed the rule, claiming it would cause “fragmented care and reduced access for patients.”
The American Hospital Association sent a letter to Dr. Mehmet Oz, CMS administrator, opposing the change on behalf of its 5,000 member hospitals.
“While we appreciate CMS’ commitment to reducing inappropriate duplication in payment under the PFS, we oppose its proposal to reduce payment by 50% when a separately identifiable office/outpatient (O/O) evaluation and management (E/M) visit is furnished on the same day as a global procedure,” the letter read.
“At a time when the Administration has prioritized improving efficiency and care coordination in fee-for-service (FFS) Medicare, this proposal would result in more fragmented care and reduced access for patients,” the letter concluded.
CMS did not immediately respond to the Daily Signal’s request for comment.
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[ H/T The Daily Signal ]
