The Impact of Federal Health Reform on Your Practice
For example: Medicare payment changes H.R. 3590 includes a number of improvements that will result in immediate, significant Medicare payment increases for many physicians, including:
• Family medicine, internal medicine, geriatric and pediatric specialists whose Medicare charges for office, nursing facility and home visits comprise 60 percent or more of their total Medicare charges will be eligible for a 10 percent bonus payment from 2011–2016.
• General surgeons performing major surgery in health professional shortage areas will be eligible for a 10 percent bonus payment for these services from 2011–2016.
• For 2010, Medicare will increase psychotherapy services payments by 5 percent.
• In 2010 and 2011, Medicare will reduce the GPCI payment adjustment for physician practice expenses in rural and low-cost areas. Physicians in 42 states, Puerto Rico and the Virgin Islands will benefit from these geographic payment adjustments by 2011.
• Incentive payments of 1 percent in 2011 and 0.5 percent from 2012–2014 will continue for voluntary participation in Medicare’s Physician Quality Reporting Initiative (PQRI). An additional 0.5 percent incentive payment will be made to physicians who participate in qualified practice-based learning programs through specialty boards.
Medicaid payment changes
There is still separate legislation, the Health Care Education Affordability Reconciliation Act (H.R. 4872), pending that would increase Medicaid payments to family medicine physicians, general internists and pediatricians for evaluation and management services and immunizations to at least Medicare rates in 2013 and 2014.
Claims processing simplification
National rules will be developed and implemented between 2013 and 2016 to standardize and streamline health insurance claims processing. Physicians should benefit from these changes. It will be easier to track claims and, in many cases, should improve physician revenue cycles and lower overhead.
Requirement to offer employee coverage
Physicians with 50 or more employees are required to offer health insurance coverage to their employees. Those who don’t can be assessed fees effective in 2014. Physicians with 50 or fewer employees (the vast majority of physician practices) are exempt from this requirement. A range of small business tax credits will also be established for employers who contribute at least 50 percent of coverage for employees.
In the weeks ahead, Practice Builders will be monitoring other issues and changes resulting from national healthcare reform. In the mean time, we will be helping our clients develop marketing strategies to meet their changing needs in the marketplace.
• Family medicine, internal medicine, geriatric and pediatric specialists whose Medicare charges for office, nursing facility and home visits comprise 60 percent or more of their total Medicare charges will be eligible for a 10 percent bonus payment from 2011–2016.
• General surgeons performing major surgery in health professional shortage areas will be eligible for a 10 percent bonus payment for these services from 2011–2016.
• For 2010, Medicare will increase psychotherapy services payments by 5 percent.
• In 2010 and 2011, Medicare will reduce the GPCI payment adjustment for physician practice expenses in rural and low-cost areas. Physicians in 42 states, Puerto Rico and the Virgin Islands will benefit from these geographic payment adjustments by 2011.
• Incentive payments of 1 percent in 2011 and 0.5 percent from 2012–2014 will continue for voluntary participation in Medicare’s Physician Quality Reporting Initiative (PQRI). An additional 0.5 percent incentive payment will be made to physicians who participate in qualified practice-based learning programs through specialty boards.
Medicaid payment changes
There is still separate legislation, the Health Care Education Affordability Reconciliation Act (H.R. 4872), pending that would increase Medicaid payments to family medicine physicians, general internists and pediatricians for evaluation and management services and immunizations to at least Medicare rates in 2013 and 2014.
Claims processing simplification
National rules will be developed and implemented between 2013 and 2016 to standardize and streamline health insurance claims processing. Physicians should benefit from these changes. It will be easier to track claims and, in many cases, should improve physician revenue cycles and lower overhead.
Requirement to offer employee coverage
Physicians with 50 or more employees are required to offer health insurance coverage to their employees. Those who don’t can be assessed fees effective in 2014. Physicians with 50 or fewer employees (the vast majority of physician practices) are exempt from this requirement. A range of small business tax credits will also be established for employers who contribute at least 50 percent of coverage for employees.
In the weeks ahead, Practice Builders will be monitoring other issues and changes resulting from national healthcare reform. In the mean time, we will be helping our clients develop marketing strategies to meet their changing needs in the marketplace.