M.D.s May Want To Try Patient Modifiers; Payment Will Be Affected

A patient is admitted to the hospital for exacerbation of chronic obstructive pulmonary disease (COPD), where her care is managed and coordinated by a hospitalist. Because the COPD is new, the hospitalist consults a pulmonologist, who winds up treating the patient after discharge as well. Sometime soon, the hospitalist and the pulmonologist, like all physicians who treat Medicare patients, will have to add new modifiers to their 1500 claim forms that describe their relationship to the patient. But it’s unclear how the modifiers will fit with real-world clinical experiences and affect payment.

The modifiers, which are required by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, are voluntary for now, but that won’t last forever, says attorney Richelle Marting, with the Forbes Law Group in Overland Park, Kansas. They are designed to capture the patient relationship categories and codes that are an integral part of the Medicare Incentive Payment System (MIPS) under MACRA, she says. In the COPD example, the hospitalist’s relationship with the patient was episodic/broad, and the pulmonologist’s relationship was episodic/focused while she was in the hospital and continuous/focused post-discharge—in theory, anyway— according to definitions developed by CMS.

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