Does Medicare use CPT codes for payment?

For Part B services, Medicare pays physicians based on the services they provide.  The American Medical Association (AMA) developed Current Procedural Terminology (CPT) codes to create a taxonomy of procedures that physicians perform.  Does the Centers for Medicare and Medicaid Services (CMS) use these codes for payment? The answer is yes and no.  Officially, CMS…

Center for Medicare and Medicaid Innovation

Medicare and Innovation in the same sentence?  Yes indeed. As part of Health Reform [i.e, Patient Protection and Affordable Care Act (PPACA)], the government mandated the creation of the Center for Medicare and Medicaid Innovation (CMI). What does CMI do?  “The stated purpose of the CMI is to test innovative payment and service delivery models…

Health Spending Climbs to 16.2% of GDP

From the CMS Office of the Actuary: U.S. health care spending growth decelerated in 2008, increasing 4.4 percent compared to 6.0 percent in 2007, as spending growth slowed for nearly all health care goods and services, particularly for hospitals. Health spending growth for state and local and private sources of funds also slowed while federal…

Reference Pricing

What percentage of your prescription drug costs should your insurance company cover?  You may say “100%, of course!”  However, if health insurance cover all pharmaceutical costs this will drive up premiums.   One solution to this problem is reference pricing.  If generics are available for $10 and name brand drugs are available for $100, the…

Should low quality hopsitals be given more or less money?

Recently, the San Diego Union Tribune reported that the Sharp Grossmont Hospital in eastern San Diego county was cited for a number of preventable deaths. Reporter Cherl Clark found numerous problems, which included: “staff members restraining a highly medicated, 25-year-old man with schizophrenia in such a way that he was allowed to suffocate. In addition,…

Pay first, evidence later.

Merrill Goozer reports (“CMS okays heart scan…“) on how Center for Medicare and Medicaid Services (CMS) has reversed a policy to stop paying for heart scans.  There has been no clinical evidence to show that these expensive heart scans identify heart disease any better than less expensive procedures (i.e.: stress tests). Physician revenue, however, would…