Medicare Compliance & Reimbursement
Big Changes May Loom For Surgical Reimbursement
Bad news for hospitals.
The General Accounting Office is calling on the Centers for Medicare & Medicaid Services to stop paying for services provided by assistants-at-surgery under the physician fee schedule and start bundling the services into hospital inpatient prospective payment system payments.
In the January report "Medicare: Payment Changes Are Needed for Assistants-at-Surgery" (GAO-04-97), the watchdog agency maintains that, under the current system, hospitals don't have to adjust their payments for surgical care when Medicare pays an assistant through the PFS. And as physicians continue to delegate an increasing number of surgical tasks to assistants, paying for these services under the PFS offers no financial incentives to steer doctors toward using that assistant only when medically necessary.
Additionally, the GAO found that no uniform standards or licensing exists to assess the experience and education required for assistants-at-surgery. The agency says Congress should consider legislating changes to the way Medicare pays for assistants-at-surgery.
To see the report, go to http://www.gao.gov/new.items/d0497.pdf.
Lesson Learned: Physician practices are looking at more profit on the chopping block if if Congress takes up the torch on consolidating assistants-at-surgery payments.
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