Protect Same-Day Care for Medicare Patients

Medicare is considering a payment policy that could create a financial disincentive for physicians to provide medically necessary evaluation and treatment during the same visit.

What Is Medicare Proposing?

CMS is proposing changes to Medicare physician payment when a separately identifiable evaluation and management (E/M) service is furnished by the same physician or physician group on the same day as certain procedures with a 0-, 10-, or 90-day global period.

Under the proposal, when qualifying services are performed on the same day, the highest-valued service would be paid at 100%, while the other
service or services could be paid at 50%.

The concern is that this payment structure could create a financial incentive to separate clinically appropriate services into different
encounters—even when evaluating and treating the patient during the same visit is medically appropriate.

Why Does This Matter to Patients?

In orthopedic care, a patient may come to an appointment with a new or worsening condition. After evaluating the patient and determining
that a procedure is medically appropriate, the physician may be able to provide treatment during that same encounter.

Examples can include injections, aspirations, biopsies, and other procedures that may appropriately occur after the physician has
evaluated the patient’s condition.

Separating services into additional appointments can mean more time away from work, additional transportation, additional administrative
burden, and potentially delayed treatment.

What Can You Do?

CMS is accepting public comments on the proposed rule. You can submit your own comment directly to the federal government through
Regulations.gov.

We’ve provided a sample comment below. You are encouraged to read it, modify it, and add your own experiences or reasons for opposing the
proposal.

Your Comment

Re: CMS-1848-P – Proposal concerning E/M services furnished on the same day as a global procedure. I am writing to express concern regarding CMS’s proposal to reduce payment when a separately identifiable evaluation and management (E/M) service is furnished by the same physician or physician group on the same day as a procedure with a 0-, 10-, or 90-day global period. I urge CMS not to finalize this policy. In orthopedic practice, same-day evaluation and treatment is frequently medically appropriate and beneficial to patients. Thank you for considering this comment.