3.36% Cut in The Proposed 2024 Medicare Physician Pay Schedule

3.36% Cut in The Proposed 2024 Medicare Physician Pay Schedule

Special thanks to the MMBA East Chapter for putting together this analysis of the proposed 3.36% reduction in the 2024 Medicare physician payment schedule. Visit their site here to access more valuable news and resources!


What’s the news:

The AMA is emphatically stating that the proposed 3.36% reduction in the 2024 Medicare physician payment schedule is ill-advised, posing a threat to the accessibility of high-quality physician care for the 50 million plus elderly individuals enrolled in Medicare. The AMA President emphasized that with escalating costs associated with medical practice; another year of Medicare payment cuts not only puts patient access in jeopardy but also endangers the viability of physician practices that communities rely upon. These cuts are deemed both unsustainable and morally unacceptable.

In a comprehensive 120-page comment letter (available in PDF format) submitted to the Centers for Medicare & Medicaid Services (CMS) regarding the Medicare physician payment schedule, the AMA pointed out that physicians are confronted with a threefold challenge as impending pay reductions loom on various fronts. The proposed 3.36% decrease can be attributed to two factors. Firstly, a 1.25% reduction arises from a temporary legislative update, and secondly, there is a negative budget-neutrality adjustment associated with the introduction of a CMS-developed office visit add-on code.

Why it’s important:

Even prior to the onset of rampant inflation and the epidemic, physicians were grappling with an unsustainable trajectory. When adjusted for inflation, Medicare physician payment has effectively declined by 26% from 2001 to 2023, and this is before factoring in additional inflation and recent cuts. Moreover, in 2023, physicians experienced a 2% reduction in pay. Unlike other providers, physicians lack an automatic increase to offset inflation.

Furthermore, the AMA has received reports indicating that a greater number of physicians and group practices may face penalties under the Medicare Merit-based Incentive Payment System (MIPS) in 2024, based on the recently released feedback for the 2022 performance period. These penalties could lead to reductions in Medicare payment of up to 9%. Notably, MIPS were largely on hold during the 2020 and 2021 performance periods due to the COVID-19 public health emergency. The AMA expresses significant concerns that this could unfairly penalize physician practices, particularly smaller, independent, and rural practices, due to a lack of awareness about the expiration of automatic COVID-19 flexibilities.

Recently, CMS released performance feedback and final scores for MIPS for the 2022 performance year. These scores will determine whether a physician receives a positive, neutral, or negative payment adjustment on Medicare services provided in 2024. Physicians can access this information on the Quality Payment Program website using their HCQIS Access Role and Profile (HARP) credentials. For those who believe there was an error in the calculation of their MIPS final score, CMS offers a targeted review process, with requests to be submitted by Oct. 9.

Furthermore, reductions in physician payment rates will significantly hinder access to care for Medicare patients. The Medicare Trustees have explicitly cautioned that access to physicians for Medicare patients could be seriously compromised in the long term if payment rates do not adjust. Delays in care, particularly among underserved populations with limited access to healthcare, are linked to poorer health outcomes and inequitable healthcare delivery.

AMA President emphasizes, “Policymakers have a responsibility to rectify the Medicare system and prevent these consequences. As physicians, we owe our patients our utmost efforts to ensure that healthcare access is not curtailed. Together with our allies in organized medicine, we are committed to ensuring that both CMS and Congress hear this perspective.”

Momentum is growing for reform. In March, the Medicare Payment Advisory Commission, for the first time, recommended a physician payment update tied to the Medicare Economic Index—the government’s gauge of inflation in medical practice costs. Additionally, in April, a bipartisan group of House members introduced a bill advocating for annual inflation updates to the Medicare pay schedule based on the Medicare Economic Index.

In July, a bipartisan group of 101 House members signed a letter urging urgent action to address challenges in the healthcare system, which has been exacerbated by the pandemic and physician burnout. The letter highlights the problematic Medicare payment system, noting that physician practices are struggling to remain open amidst surging inflation and escalating costs.

The American Medical Association (AMA) has emphasized the urgency of reforming Medicare physician payment as a top advocacy and legislative priority. To provide physician advocates and policymakers with a comprehensive understanding of the intricate landscape surrounding Medicare physician payment reform, the AMA’s Medicare Basics series offers a detailed and accessible overview of crucial components within the payment system, highlighting the need for reform.
In its extensive comment letter, the AMA addressed various areas, including:

• Valuation of specific codes.
• Practice-expense data.
• Evaluation-and-management (E/M) add-on code.
• Appropriate Use Criteria for Advanced Diagnostic Imaging Program.
• Supervision of residents in teaching settings.
• Telehealth and remote monitoring.
• Medicare Shared Savings Program accountable care organizations.
• Diabetes screening.
• Billing for split or shared visits.

For more information on the significance of reforming Medicare payment and to stay updated on other advocacy priorities actively pursued by the AMA, visit AMA Advocacy in Action.

Five Revenue Cycle Reports That Drive Informed Decisions

Five Revenue Cycle Reports That Drive Informed Decisions

Access to high-quality revenue cycle reports can make all the difference for practices and billing companies looking to optimize their processes. Without a proper understanding of performance, how can you possibly improve and grow your business? Today, we take a look at five critical revenue cycle reports every business doing billing should use to drive informed decision-making.

Aging and or Denial Reports

What are Aging and Denial Reports?

Aging reports provide a breakdown of outstanding accounts receivable by the number of days a claim has been outstanding (e.g., 30 days, 60 days, 90 days, etc.). Your aging report should also include the status of your claims, including denial analysis, which enables you to understand the reason any of your claims have been denied by insurance companies. Think of your aging report as your “home base.” This report succinctly tells you where in the process your claims are, and what action (if any) you need to take next.

Why Aging and Denial Reports Matter:

These reports help identify overdue claims and allow the billing department to prioritize follow-up efforts for unpaid or underpaid claims. 

Once you have an understanding of why your claims are being denied, you can identify which steps to take to improve claim accuracy and reimbursement rates. Addressing the root causes of denials can significantly improve claim accuracy and reimbursement rates.

Payment Posting Reports

What are Payment Posting Reports?

These reports detail the payments received from insurance companies and patients. Payment posting reports provide insights into the accuracy of payments and identify discrepancies that may require correction, which helps reconcile payments with claims.

Why Payment Posting Reports Matter:

Accurate payment posting is essential for proper revenue recognition. Your payment posting report ensures your payment collection function is performing as it should, and your business is on the path to growth.

Adjustments Reports: 

What are Adjustment Reports?

Adjustment reports enable your business to track any changes or adjustments made to financial transactions or accounts. 

Why Adjustment Reports Matter?

Businesses use adjustment reports to track any changes made to charges using standard and customizable codes to help insure accuracy, transparency, compliance and accountability in financial reporting.

Provider Productivity Reports

What are Provider Productivity Reports?

These reports assess the performance of individual healthcare providers, such as physicians or nurse practitioners. Provider productivity reports often include metrics like the number of patient encounters, charges, collections, and productivity per provider. 

Why Provider Productivity Reports Matter:

Monitoring provider productivity can help identify areas for improvement and optimize revenue generation for your business. This report is particularly useful for practices, enabling them to measure their overall operational effectiveness and evaluate productivity in several critical areas.

Patient Balance Reports: 

What are Patient Balance Reports?

Patient balance reports enable you to dive deep into individual patient balances, isolating patient balances from insurance.

Why Patient Balance Reports Matter: 

Patient balance reports enable your business to maximize patient payment collection by highlighting patient balances and excluding insurance. Using this information, businesses can determine where their collection efforts are best focused.

Custom Reports are Critical! 

Remember, most reports generally include the same data, but present it through different lenses depending on what you are trying to analyze. Top-rated medical billing software offers customizable reports with different details and supporting information. You should be able to set custom criteria and sort by month, by week, or by individual.

While these five reports are typically considered essential for medical billing and revenue cycle management, the specific reports you need may vary based on your business’s size, specialty, 

and unique billing processes. If you are looking to get more out of your medical billing reporting, look no further than EZClaim. Our affordable, easy-to-use medical billing software enables your business to customize its revenue cycle reports to meet its particular needs, ensuring you have all the data you need to make informed decisions. We are your partner in medical billing success, from claims processing to compliance. Schedule a call today to learn more about EZClaim!