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[image: Your daily Update] January 4th, 2012 Healthcare Economist

· Why Doctors Don’t Like

Medicare<http://ptmanagerblog.com/healthcare-economist-why-doctors-dont-like-me>

Posted about 22 hours ago by [image: _portrait_thumb] Kovacek,

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Why Doctors Don’t Like Medicare

January 3, 2012 in

Medicare<http://healthcare-economist.com/category/medicaidmedicare/medicare-medi\

caidmedicare/>,

Physician

Compensation<http://healthcare-economist.com/category/supply-of-medical-services\

/physician-compensation/>|

1

comment<http://healthcare-economist.com/2012/01/03/why-doctors-dont-like-medicar\

e/#comments>

Being a doctor is difficult. You need to graduate from medical school and

learn a ton of difficult scientific concepts. You need to stay up to date

on the latest medical developments. You need to cater to sick, needy

patients (and their family). Any you need to get paid.

Earning a living is not as simple for doctors as other professions. Sure

doctors make a lot of money. But knowing how much they get paid for a

particular service is complex.

I provide an overview of the physician reimbursement system

here<http://healthcare-economist.com/2009/09/17/medicare-reimbursement-informati\

on-viii/>.

That overview does not take into account all the payment modifiers in the

Medicare’s physician reimbursement system. Consider the following payment

modifiers:

- For many procedures, Medicare pays providers for the professional and

technical

component<http://www.healthleadersmedia.com/content/PHY-92323/Learn-when-to-bill\

-for-the-professional-or-technical-component.html#%23>.

The professional component is the physician’s work and expertise; the

technical component provides reimbursement for equipment and supplemental

staff needed to perform the procedure. If the procedure is billed

globally, then the physician receives both components. If another entity

performed the technical component, then the physician is only paid for the

professional component. For instance, for lab tests, the lab may run the

test (technical component) but the physician would be the one interpreting

the test (professional component).

- If you assist in a surgery, you receive

16%<http://www.supercoder.com/articles/articles-alerts/gca/distinguishing-modifi\

ers-80-81-82-and-as/>of

the fee the primary surgeon does.Under some circumstances, the

individual skills of two surgeons are required to perform surgery on the

same patient during the same operative session. If you are a co-surgeon

(rather than an assistant at surgery), you receive

62.5%<https://www.highmarkmedicareservices.com/refman/chapter-22.html>of

the typical reimbursement for that surgery.

- If you perform a bilateral surgery–a surgery done on both sides of the

body (e.g., right arm and left arm)–then you receive 150% of the payment

you would have received from doing a unilateral surgery.

- When multiple procedures are performed through the same endoscope,

payment will be made for the highest valued endoscopy (100% of the

allowance) plus the difference between the next highest and the base

endoscopy.

- If you perform multiple surgeries in the same day on the same patient,

you do not get paid the same amount as if these were performed on multiple

days. The highest valued procedure is paid 100% of the allowance. For the

second through the fifth highest valued procedures, the physician receives

50% of the typical payment amount.

- If you are a physician assistant, nurse practitioner, or a registered

dietitian or nutritionists; you receive 85% of the payment an MD would

receive for performing the same service.

- If you are a clinical social worker, you receive 75% of the payment an

MD would receive for performing the same service.

- If you are a certified nurse midwife, you recieve 85% of the payment

an MD would receive for performing the same service. If you are a midwife,

you only receive 65%.

If you don’t think Medicare is bureaucratic, just take a look at those

rules.

via

healthcare-economist.com<http://healthcare-economist.com/2012/01/03/why-doctors-\

dont-like-medicare/>

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