A 2018 report on Medicare Payment Policy issue by the Medicare Payment and Advisory Commission, an independent congressional agency that advises Congress on Medicare-related issues, found that healthcare services billed under E/M codes, which include many provided by rheumatologists, were greatly undervalued. This was largely due to a lack of credit for the prolonged, specialized training required to become a rheumatologist, Dr. Edgerton says.
“This needs to be reflected in the E/M codes, and unfortunately, it has not been. Reimbursement has been instead focused on procedure-based activities. Procedures do not adequately reflect the extended training and specialized skills that rheumatologists possess,” he says.
In its announcement, the CMS cited that the updates reflected an administration-wide strategy to provide patients with “better accessibility, quality, affordability, empowerment, and innovation” through these updates. In addition to updating potentially undervalued codes that would reflect the value of cognitive care, the 2020 proposed rule includes implementation of Section 2005 of the Substance Use-Disorder Prevention that Supports Opioid Recovery and Treatment for Patients and Communities Act, which creates a new Medicare Part B benefit for opioid treatment programs. The proposal also expands the list of reimbursable Medicare telehealth services, including services like tobacco and alcohol use counseling, depression screenings, obesity-related behavioral counseling, caregiver assessment and pharmacologic management.
CMS will accept comments to the proposed rule through Sept. 27. The final rule will go into effect on Jan. 1, 2020. The ACR’s leadership will continue to interact with CMS on these issues and provide further feedback in written comments, says ACR President Paula Marchetta, MD, MBA.
