09/26/2014

Medicaid Cuts for GI Services

Feedback Requested from Your GI Doctors

Medicaid Cuts for GI Services

Feedback Requested from Your GI Doctors

 

At a time of Medicaid expansion in the state, the Ohio Department of Medicaid has reduced reimbursement for the physician professional fee component of several upper and lower endoscopy procedures, including colonoscopy, when performed in the Ambulatory Surgical Center or Hospital Outpatient Department/Hospital settings.

 

The physician professional fees for some GI procedures have been reduced by more than 50% in these settings putting them below office-based reimbursement rates. This reduction in reimbursement was unexpected.

 

While you probably have not seen these cuts from the center side of the business, the physician practice side most certainly has seen a significant reduction.

 

National and state stakeholder organizations, including the Ohio Association of Ambulatory Surgery Centers, Ohio State Medical Society and the Ohio Gastroenterology Society are in the process of scheduling a meeting with Medicaid to discuss these changes the agency’s rationale and the potential impact these changes could have on patient access and practice operations. 

 

A list the GI procedures impacted by this policy change along with the payment reductions can be found here - GI Fees Impacted by Change

 

In preparation for our meeting with the Ohio Department of Medicaid, please have your physician GI practice complete a brief survey regarding the reimbursement changes for GI procedures and the potential impact they will have on their practice. They should complete this survey by Oct 3.

 

A full list of reimbursement changes for all procedures can be found can be found online.

 

Please forward this message to your GI professionals and their office administrators to ensure we receive as much input as possible.

 

For additional information on this issue, please contact the OAASC's Randy Leffler at rleffler@oaasc.net or at 614-358-0177.