“Do not wait to strike till the iron is hot; but make it hot by striking”- William B. Sprague
The proposed CMS payment rule for evaluation and management services is, in my opinion, the greatest threat to the viability of podiatric medicine that I have seen. Podiatrists are physicians under Medicare. As such, we were always treated the same as physicians. However, this proposed CMS payment rule treats us different than physicians as it relates to our reimbursement for evaluation and management services. CMS wants to “collapse” the different levels of evaluation and management (CPT 99212-99215, 99202-99205) and create a single code for an established patient and a second code for a new patient. They will value these new codes as an average of level 2 – 5.
However, CMS will create a different code for podiatrists which will be valued lower, somewhere between a level 2 and 3. So we will be getting a lower reimbursement than the rest of medicine.
The rational for podiatry getting a lower reimbursement is that podiatrists tend not to bill level 4 or 5. But the new code will result in lower reimbursement for podiatrists than what we have now, and we will have no ability to bill higher for complicated patients. Considering the complex work podiatrists preform on very sick patient populations, it is wrong not to have equal reimbursement to physicians. It is also likely that many podiatric visits do indeed qualify as a level 4 or even 5 but may be billed lower for fear of audits.
This new payment rule will hurt podiatry. It will hurt student recruitment. It will hurt our credibility within the medical community. And it will have a detrimental effect on our compensation for the essential medical services we provide.
CMS has an open comment period till September. I have spoken to representatives of our national partner; the American Podiatric Medical Association. I am pleased that they are acting aggressively to oppose this proposed rule. That includes advocacy directly to CMS regulators using their consulting firm, Hart Health Strategies.
As the largest state component to APMA, I felt NYSPMA needs to also contribute to this effort. I have spoken to our consultants and experts regarding possible action NYSPMA can take to help APMA oppose this proposed rule.
This past week the NYSPMA board met via emergency conference call to discuss this. I am please to inform you that the board has authorized funding for NYSPMA to retain the Washington branch of Greenberg Traurig to work with APMA to oppose this rule. This prestigious law firm with a robust healthcare practice and experience with regulators will work with and support APMA, and report to NYSPMA.
During a time of crisis, like this, we all must work together to protect podiatry. I have also established a small task force consisting of our President Elect, Daniel Keating, Trustees Charles Lombardi and Nicholas D’Angelo, and our attorney Matthew Feldman to work on this issue as well.
We will keep you informed of developments, and we may need some action of our membership as well. Thank you for your membership. If we do not have strong national and state association, we would have no ability to advocate for fair treatment for podiatry.
If you have not signed up for the Podiatry Protection Program, you still can. Please take advantage of this important member benefit. You can’t afford not to be without. We are extending the enrollment deadline to Friday August 17, 2018. The application can be found here.
Best regards,
Paul Liswood, DPM
President, NYSPMA
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Don’t forget to visit our Member Partner Program section on our website to take advantage of the numerous savings opportunities for members. Our benefit partners include medical insurance, travel, entertainment and dining packages, car rentals, business supplies, risk management, coding and reimbursement insurance and practice billing solutions. We also have our benefits listed in a brochure developed by our Membership Committee.
Legal Tip - Who Needs the Podiatry Protection Program? (PPP Deadline August 17)
by Andrew Feldman
General Counsel, New York State Podiatric Medical Association
If your answer is yes to all of the following, you don’t need the PPP:
- I am very confident in my abilities as a podiatrist, and don’t feel that I need this type of program. I am well-liked by my staff and patients who I know would never complain about or retaliate against me.
- I don’t anticipate receiving any claims for reimbursements from an HMO, third-party payer or other entity. I am very cautious and careful, and could always handle those matters myself. The fact that I could not get the benefit of consultation and expert opinion and advice, does not bother me, since I know how good I am at fighting these kinds of claims and I trust auditors to be fair to me.
- I am particularly not concerned about Medicare reimbursement claims or meaningful use claims. I know that there are multiple regulations out there and all sorts of appeals that I can take, but I am fairly confident that I can handle myself, and never need any guidance or assistance.
- I feel the same about any HIPAA claims or OSHA claims against me. Again, I am very confident in my own skills and do not need any assistance in those areas if I am ever challenged. I am also certain that I fully comply with these laws and regulations.
- I have heard about my colleagues having workers’ compensation claims made against them, as well as claims by the New York State Department of Taxation, for which they are covered under the PPP program, I don’t anticipate ever receiving those kinds of claims, so I don’t need coverage for that.
- I know that there could be employment issues in my office, and issues relative to how I have classified individuals and how I pay them, should issues arise in those areas, I feel that I am a strong advocate and can deal with regulatory bodies and the government in convincing them that I am correct.
- I also have a malpractice policy in place, so I don’t need any other coverages, even though I know the PPP benefits offered to me by the Association cover areas where I have exposure that my malpractice policy does not cover me for.
- I know I can always hire legal counsel to help me if necessary. I don’t mind paying $250 to $400 per hour for legal assistance, even though I know I can get the benefit of concierge legal services at a preferred billing rate.
- I wake up every day comfortable and secure in my practice knowing that none of the issues that other practitioners potentially face, who have joined the PPP program and have received benefits and additional cost savings, will ever impact me.
If I have an occasional moment of doubt, I comfort myself by polishing my crystal ball and reassuring myself about the future.
Join the PPP program now and don’t rely on your crystal ball. The enrollment deadline is Friday August 17, 2018. The application can be found here.
CPR Billing and Coding Tip of the Week
To assist you and your staff in keeping up to date with insurance, billing and coding changes, we have added this new Tip of the Week feature. Each week, we will be providing a “tip” to help you navigate the increasing complexity of reimbursement and compliance. We encourage you to visit our Billing and Coding Portal.
Medicare Will Likely Face Pushback on Physician Pay Changes
Federal officials will likely encounter some resistance to a proposed overhaul of Medicare's payment for evaluation and management (E/M) services, which could raise this reimbursement for some specialties while lowering it for others. E/M services make up about 40% of charges for Medicare's direct physician payment, meaning that any change in the billing approach will have a wide impact.
CMS Administrator Seema Verma has said the expected reduction in "documentation burden" from changes to Medicare's E/M codes should outweigh "any small negative payment adjustments." However, if you refer to Table 22 of CMS draft physician fee schedule, which is on page 367 (see link below). It shows certain predicted effects of the new E/M proposal.
Obstetricians and gynecologists would be in line for the biggest potential bump — a 4% gain — from E/M changes, according to Table 22, while podiatry and dermatology would take the biggest hit — a 4% decrease. The table details what CMS expects would happen to payments under a proposed single payment rate for E/M patient visits for what are now classified as level 2 to 5 visits. The chart also factors in other variables, including technical adjustments to practice expense per hour value.
Nurse practitioners might see a 3% bump, while physician assistants are among the group that might get a less than 3% increase in overall payment.
See link below for the proposed Centers for Medicare & Medicaid Services (CMS) draft:
draft 2019 update of the physician fee schedule.
Become a Mentor for a Young Podiatrist
Podiatric student recruitment is important to the future of our profession. The AACPM and the DPM Mentors Network have created materials for promoting careers in podiatric medicine, including a college information booklet, a student brochure, foot pens, Mentors Network stickers, and cell phone wallets. Whenever you request resources for your office or attend a student recruitment event, the AACPM will provide these materials to you. Additionally, you can still help the AACPM reach their goal of 500 mentors. Sign up to become a mentor here. NYSPMA has signed up several new mentors for the AACPM during the past few months. Thank you. The future of our profession will be more secure with strong mentors, just as many of us have had strong mentors early in our careers so it’s important to play it forward to thank those who mentored us along the way.
NYSPMA Job Board
For most, seeking a new career takes a lot of time and patience. Job hunting has turned into a science. Avoid wasting your time and patience by using the right resources to find your next career. The NYSPMA Job Board is the best channel to find open positions in our industry. Recruiters posting on the NYSPMA Job Board are looking for quality candidates that stand out from the rest. Be sure to upload your resume and start searching the open positions posted on the NYSPMA Job Board today. Click here to get started!
NYSPMA: Connect on Facebook & Twitter
NYSPMA has a Facebook page and is now on Twitter. These pages provide Association announcements and updates. We are always looking for great news stories to share on our pages. If you’ve recently been quoted in the media, received an award, launched a new project or have relevant news to share, please email lsales@nyspma.org.
Poster for Your Office: We have developed an 8 1/2 x 11 Full Color Poster/Flyer that can be displayed in your office to encourage your patients to visit our site to stay up to date on the latest foot health news and get updates on diabetes, bunions, heel pain...and more.
