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I've seen a great deal of chatter on the MF bulletin boards about how wonderful Medicare is. Well, Medicare is not a favorite of most physicians: low reimbursement, Draconian penalties for improper coding, and significantly higher paperwork requirements.

For me, the coding issue is the big deal. Traditionally, physicians use the current CPT code book for diagnosis and treatment codes; it is the accepted standard for "how the heck do I bill for this pap smear, management of diabetes, evaluation of chest pain" etc. Medicare, in its infinite wisdom, has its own set of special codes; if I inadvertently use the standard CPT code (the one used for 98% of my patient base) for a procedure rather than the special code that Medicare has set up, not only is the claim denied but I am technically committing Medicare fraud. Guess what? Medicare billing fraud carries HIGH financial penalties as well as the potential for jail time. Trying to figure out Medicare's rules for billing and coding is like trying to figure out the tax code: if you ask 5 IRS agents about itemized deductions, you'll get 5 different answers. Medicare is the same way.

The point of this rant is that Medicare has just added their annual wrinkles, just as we're getting 2009 rules figured out. First off, specialists can no longer bill "consultation" codes. By definition, a consultation is a request by a primary care physician that a specialist evaluate and manage a problem that is beyond the primary care physician's level of expertise. Consultations are generally billed at a higher rate than routine office visits because of the theoretically increased level of diagnostic and management difficulty. Medicare has just zapped that; specialists will get paid less for their expertise than they were before. Adding insult to injury, Medicare now requires that all physicians who see Medicare Advantage patients undergo annual compliance training; this is Medicare specific, has nothing to do with clinical management only the bureaucratic requirements, and is above and beyond our annual Continuing Medical Education requirements (generally 20+ hours) and our annual specialty board certification maintenance requirements.

So, for the "privilege" of seeing Medicare patients for less reimbursement than I would make seeing a patient with private insurance, I have to complete even more annual training all while looking forward to receiving even less compensation for the tough cases.

So for all of those who think that using Medicare as an example of how a great government run health insurance should work, if you get your wish, there will be a whole lot of patient access issues as physicians stop participating government run plans.

Did I mention that physicians are prohibited by law from collectively bargaining?
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