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ADVOCACY

Payment and Reimbursement

Medicare Physician Payment

The Medicare physician payment schedule determines the reimbursement rates for all Medicare Part B services. Every summer, CMS releases a proposed rule regarding the upcoming year’s physician payment schedule. In this major proposed rule, CMS proposes relative value units (RVUs) for the upcoming year, updates to geographic practice cost indexes, and changes to other Medicare Part B payment policies. The proposed rule also details changes and updates to the CMS Quality Programs. The physician payment schedule final rule is published in the fall. 

Ambulatory Surgical Center (ASC) Payment 

The ASC is an important part of the practice of gastroenterology, providing a safe, patient friendly and cost effective environment for the provision of medical services. About 40 percent of all colonoscopies are provided in ASCs and the majority of ASCs in which gastroenterologists practice are single specialty centers. Because of their single specialty structure, gastrointestinal ASCs are particularly sensitive to changes in Medicare payments. Medicare reimbursement for gastrointestinal services provided in the ASC setting has been declining, causing a widening disparity between payment rates for ASCs and hospital outpatient departments (HOPDs).

New Payment and Delivery Models 

The CMS Innovation Center sponsors pilot projects in different types of new payment and service delivery models. Their work includes developing and testing new models such as accountable care organizations and bundled payment systems.

Coding

Proper coding is essential for ensuring the maximum allowable reimbursement for the services provided. ASGE provides several resources to help physician practices improve billing procedures and adjust to new regulations.