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01/18/2023
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Paul Kesselman, DPM
As has been noted here in the past, there is no doubt a double standard and an uneven playing field when it comes to prosecuting physicians vs. insurance companies. Why is that? Because physicians and hospitals are the low-lying fruit, while the insurance companies can afford to fund lobbyists and legal teams with an endless stream of finances. They also have politicians in their back pockets.
CMS also wants to get out of the risk-taking business; thus, the insurance companies will get plenty of leeway from CMS and the OIG and get away with these financial crimes against society with no more than a slap on the wrist. Unless or until it can be shown that a Medicare Advantage Plan has caused undue harm to a patient, they will continue to get away with impunity.
There is still plenty that physicians can do about this. It starts with the novel idea that politicians, attorneys and the MBAs, actuaries, and others with advanced degrees in business are limited in their abilities. When was the last time you saw one of them examine or treat a patient, admit a patient to hospital, treat infections, perform surgical procedures, prescribe medications, write orders, along with all the other daily tasks only physicians can execute? And let’s not forget that politicians serve on our behalf. They should be properly remembered on Election Day!
Paul Kesselman, DPM, Oceanside, NY
Other messages in this thread:
11/18/2024
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Ron Freireich, DPM
This is pathetic already. While other professions see salary increases in the double digits (most recently dock workers got a 62% increase and Boeing employees a 38% increase), the only time the medical profession talks in double digits regarding salary is the 29% DECREASE in Medicare pay since 2001. From what I can see, the "fix" offered in a discussion draft is a 4.73% increase in current pay rates and factoring in CMS' estimate that practice cost expenses will rise by 3.6% in 2025, that amounts to a 1.13% pay increase.
And don't forget this proposed "increase" would only apply to the roughly 46% of Medicare part B patients since more that 54% of our Medicare patients are enrolled in Medicare Advantage plans which is even worse regarding physician reimbursements. Whatever the "powers that be" have done and are doing is NOT working. This should not be acceptable. Something has to change.
Ron Freireich, DPM, Cleveland, OH
08/17/2024
RESPONSES/COMMENTS (MEDICARE NEWS)
RE: Count on Medicare's Advanced AI Sleuth System to Flag and Audit Suspected "Abusive" Foot Skin Substitute Providers
From: Lawrence Rubin, DPM
It is essential to follow the Medicare OIG directive to create and put into action its, "Solo and Small Group Practice Compliance Program." The OIG advises providers that if their implemented compliance plan content justifies the billing of their codes and their documentation, this will be a "mitigating factor" in whether or not punitive action is taken.
Creating and implementing a compliance plan should be due diligence for any savvy wound care provider. Having a provider and staff compliance plan in action is the best safeguard against adverse Medicare determinations. The LEAP Alliance advocates for the provision of value-based amputation prevention foot care, and this includes wound care.
Lawrence Rubin, DPM, Las Vegas, NV
07/17/2024
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Keith L. Gurnick, DPM
When we find out that the efforts of the APMA improve our overall Medicare pay cut down to 1.5% instead of the 3% as expected beginning calendar year 2025, should we all jump up and down and give the APMA another high 5 for a job well done?
Keith L. Gurnick, DPM, Los Angeles, CA
07/16/2024
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Paul Kesselman, DPM
Considering the inflationary rates since 2001, this translates to a 22% reduction in pay in the last twenty years. This, combined with millions of baby boomers entering the Medicare system (57% by 2050) along with many providers retiring from practice, is going to create significant delays in accessing healthcare.
There clearly are indications that CMS is not really interested in the concerns of the provider, nor do they have the best interest of the patients in mind.
Paul Kesselman, DPM, Oceanside, NY
11/10/2023
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Robert Kornfeld, DPM
I am so happy to finally see the anger and rage about this. My question is why now? It’s like the dog who is chained to a fence. If you remove one link a day, the dog doesn’t realize he is becoming more and more limited every day until he can’t breathe. Unionizing will give doctors a voice. But will it really make a difference? They’ll just throw you a bone to keep you quiet. There are thousands of us out there who quit Medicare, quit insurance-dependency and are thriving. I’ve enjoyed the past 23 years as a direct-pay podiatrist, and no one can lower my fees but me. No one can deny my claims.
No one can delay my claims. Deductibles, co-pays, non-covered services, and meager payments are non-existent. I get paid for my services AT THE TIME OF THE VISIT. My overhead went from 70% of gross down to 20% of gross. It can be done. You just have to know how to create unique value for your services. You can make an amazing living on 8-10 patients a day. That’s called working smart, not hard. Einstein defined insanity as doing the same thing over and over again expecting a different result. So you either do something different or accept the same result.
Robert Kornfeld, DPM, NY, NY
04/12/2023
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Judd Davis, DPM
Doctor Ricciardi, please re-read the posts on this topic as you have misunderstood it. There is no 3.3% increase for you or any of us. That increased payment is being paid by our government to the insurance companies that administer the Medicare Advantage plans, as if they need to profit some more! Physicians are getting an annual pay cut with decreased reimbursement for Medicare patients that we see. In 2023, I believe it was somewhere in the 1-2% range, so if you factor in the 6-8% inflation rate of your expenses increasing, that's a 7-10% paycut this year alone. This doesn't even take into account the 2% "sequester" pay reduction that has been in place for years now. Just compare your Medicare EOBs from 2022 to 2023 and the sad truth becomes evident. The 2024 pay cut is currently set at 1.25%.
There was some good discussion about this topic 6 months ago on this forum and people seemed up in arms, but once again nothing seems to be happening as we have no effective voice to the politicians. The insurance companies are in the driver's seat and have the voice, lobbyists, and financial backing to get what they want. Without unionizing, we seem to have no voice.
Judd Davis, DPM, Colorado Springs, CO
04/10/2023
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Cosimo Ricciardi, DPM
Has the party over our 3.3% increase ended yet? I’m wondering if this 3.3% will cover the ever increasing admin costs associated with taking Medicare. Oh, and can someone remind me what the inflation rate was for 2022/2023? Boy, I can’t wait for the 3.3% to kick in!
Cosimo Ricciardi, DPM, Fort Walton Beach, FL
04/07/2023
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Farshid Nejad, DPM
The problem is the individuals representing the physicians are too weak to negotiate. It is time that we hire the best individuals who can represent medicine the way it should. We hold an important purpose in the grand scheme, but representation fails to realize this. They feel they take the high road by negotiating. There is no negotiation when it comes to the health of our nation. The day we realize this is the day we are able to command our reimbursement rates. Let’s hold our representatives' hands to the fire.
Farshid Nejad, DPM, Beverly Hills, CA
04/06/2023
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Ron Freireich, DPM
The Biden administration finalized a proposal to raise Medicare Advantage payments by 3.32% in 2024. Funny, physicians are receiving a 3.5% pay cut in 2024. Taking money from physicians and giving it to the Advantage plans who make millions in profits, say it ain't so. As the previous post stated, their pay raise comes after a lobbying campaign from insurers complaining about upcoming pay cuts. How is it that the Advantage plans can take a paycut and turn into a pay raise, while physicians keep getting paycuts.
I think the problem with who gets pay raises revolves around what CMS Administrator Chiquita Brooks-LaSure said in a statement, "Paying Medicare Advantage plans more accurately for the care they provide is how we ensure that people enrolled in Medicare Advantage can continue to access the care they deserve."
Someone needs to tell Administrator Chiquita Brooks-LaSure that physicians are providing the care, not the insurance companies. Maybe then, physicians will get paid what they deserve. This should be the perfect time for our national associations to ask CMS why are they paying the Advantage plans more money and at the same time cutting physicians' pay.
Ron Freireich, DPM Cleveland, OH
01/20/2023
RESPONSES/COMMENTS (MEDICARE NEWS)
RE: Most Medicare Advantage Payers Accused of Fraud Allegations or Settled (Brian Kashan, DPM)
From: Lawrence Rubin, DPM
Dr. Kashan wants to know how to file a complaint against a Medicare Advantage Plan. Here is information from an Internet CMS website:
How do I report a Medicare Advantage plan to CMS? Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Lawrence Rubin, DPM, Las Vegas, NV
01/19/2023
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Brian Kashan, DPM
I have been trying, for over two years, to just find a contact person within CMS to whom I can make a complaint against a Medicare Advantage plan. You would think that Medicare would have an interest in protecting its beneficiaries from fraudulent claims, enrollments, and denial of benefits that these Medicare Advantage plans are doing.
I have spoken to APMA, spent hours on the Internet looking for a contact, and actually speaking to CMS regarding a contact so that I can file a complaint. Unfortunately, there are hotlines for patients to make complaints, but it doesn't appear that there are any for physicians.
In my opinion, Medicare Advantage plans, and most insurance plans, will continue with their ridiculous rules, procedures, denials, arbitrary policies, and reduced fees as long as they can. I have always stated that unless these plans are fined significantly, they have no benefit to adhering to policies and no one is policing them.
Brian Kashan, DPM, Baltimore, MD
07/12/2022
RESPONSES/COMMENTS (MEDICARE NEWS) - PART 1B
From: Paul Kesselman, DPM
In addition to the payment decrease for 2023, CMS is proposing a disastrous revamping of the reimbursement for cellular tissue products in 2024. CMS' stated intent is to discontinue the use of "Q" codes for all CTP and reinvent them as "A" codes. These "A" codes would then be considered incidental to the provision of the appropriate CPT code.
The complexity and unconscionable absurdness of this proposal is beyond anything I have seen in the forty plus years I have been following CMS policy. This policy will cause undue harm to patients with...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
07/12/2022
RESPONSES/COMMENTS (MEDICARE NEWS) - PART 1A
From: Jack Morgan, DPM
The medical profession is under attack again by CMS. The only way out is to change Medicare reimbursement from budget neutral to cost of living! This needs to be the number one AMA, AOA, and APMA directive for all legal battles. When will medicine wake up and say we can’t afford to be viable at this rate or budget neutral position? We should all speak with ONE VOICE and make sure that all parties understand the disaster ahead in Medicine if we don’t stand up and fight now.
This constant attack on fees for doctors is not sustainable. I’m retired from clinical practice but believe, as a recipient of Medicare, that this will harm the public without any fight for the rights for doctors. Every area of practice has become more expensive but reimbursements are constantly being attacked and lowered! I’d like to hear the thoughts of those podiatrists in elected positions.
Jack Morgan, DPM, Los Angeles, CA
04/30/2022
RESPONSES/COMMENTS (MEDICARE NEWS)
RE: Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care
From: Paul Kesselman, DPM
Our case file reviews determined that Medicare Advantage Organizations (MAOs) sometimes delayed or denied Medicare Advantage beneficiaries' access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. Denied requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care and can burden providers.
Paul Kesselman, DPM, Oceanside, NY
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