CMS Proposes Changes, Improvements Throughout the Medicare Program
Question: Is Anything Being Done to Simplify Medicare and Medicaid Participation?
Answer: On April 14, 2017, the Centers for Medicare & Medicaid Services (“CMS”) announced that it wants to start a “national conversation” on cutting red tape in the regulatory process. CMS has proposed a $3 billion increase in overall spending on inpatient hospital care, an increase of 1.6 percent over the prior year’s spending. Presumably, streamlining the process and reducing the red tape will result in more of this spending actually contributing to the treatment of patients.
According to CMS, the ultimate goal is “making the health care system more effective, simple and accessible while maintaining program integrity and preventing fraud.” As set forth in the agency’s statement:
As we work to maintain flexibility and efficiency throughout the Medicare program, we would like to start a national conversation about improvements that can be made to the health care delivery system that reduce unnecessary burdens for clinicians, other providers and patients and their families.
CMS has said these efforts could involve the redesign of payment systems, “elimination or streamlining” of paperwork requirements and harmonization of Medicare policies with those used by Medicaid and private insurers, as well as recommendations for how it can “simplify rules and policies.”
CMS has indicated goals of supporting “patient-centered care” and the “doctor-patient relationship,” which are goals which have also been expressed by Tom Price, a physician and current Secretary of the Department of Health & Human Services. Time will tell whether or not these efforts will be successful and actually result in simplifying physician participation in these Federal programs.
In order for a service to patient provided by a Nurse Practitioner to be considered “incident to”, a physician must have first provided a visit with the patient and started treatment plan with that patient. The NP who is acting under the supervision of a physician and is employed by that physician, can then provide treatment “incident to” the physician’s recommendations. If there is a new problem, the process begins again. If the initial visit for a medical problem was not performed by the physician, the subsequent visits may not be billed “incident to” by the NP. I hope this clears up a common question among medical providers. -Larry Kobak, Esq., Partner, Kern Augustine, P.C.
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