Medicare Reimbursement for Orthopedic Surgery

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Medicare Reimbursement for Orthopedic Surgery
The Centers for Medicare Medicaid Services
(CMS) sets reimbursement rates for Medicare
providers and generally pays them according to
approved guidelines such as the CMS Physician Fee
Schedule. Medicare reimbursement for orthopedic
surgery follows the same set of rules however,
recently the amount of Medicare reimbursement
for orthopedic trauma surgery has fallen by
nearly one-third over the past two decades,
according to a recent study.   The current
pandemic impacted adversely for example- State
and federal COVID-19 relief packages offered
throughout the year could lead to additional cuts
down the line, leaving smaller practices already
operating on fine margins in particular
distress. While many surgeons believe that
reimbursement cuts were inevitable, one of the
biggest concerns is that the scope and magnitude
of the cuts will limit access to care when
patients need it most. It is threatening to
observe that physician payment for surgical
services is looming. Various policies from CMS in
the FY 2021 Medicare Physician Fee Schedule
(MPFS) propose to cut all orthopedic surgical
services by 5.
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Medicare Reimbursement for Orthopedic Surgery

• These policies have the potential to destabilize
  an already challenged healthcare system and
  drastically diminish the opportunity for
  physician practices to recover financially from
  the public health emergency.
• Four keys CMS updates for spine surgeons in 2021
•  
• About 300 musculoskeletal procedure codes will be
  removed from CMSs inpatient-only list over three
  years, including 67 spine codes for 2021.
• Beginning July 1, 2021, CMS will require prior
  authorization for cervical fusion with disc
  removal as well as implanted spinal
  neurostimulators.
• Under the Medicare Physician Fee Schedule, CMS
  finalized a conversion factor of 32.41, which is
  a decrease of 3.68 compared to the conversion
  factor for 2020.
• While CMS 2021 final rules spelled more bad news
  for surgeons, some spine device companies will
  benefit from the agencys transitional
  pass-through payment program, which provides
  additional payments for new devices that show a
  substantial clinical improvement over existing
  technology.

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Medicare Reimbursement for Orthopedic Surgery
While finding out the reimbursement trends for
the 20 most billed surgical procedure codes in
orthopedic trauma from 2000 to 2020 researchers
found that the majority of traumatic bone
fractures require surgical repair with some type
of hardware (internal fixation). Moreover, these
trends are varied by procedure types. Lets
understand them in detail Orthopedic Surgery
reimbursement trends Relative Value Units
(RVUs) for individual procedures is used to find
out Medicare reimbursements s is nothing but an
arbitrary multiplier that is supposed to reflect
the value of the physicians work, practice
expenses, and malpractice coverage. It is
observed that average total RVUs increased 4.4
percent for the 20 procedures from 2000 to 2020
and most of the increase was in malpractice RVUs,
with a small decrease in practice expense
RVUs. The trends varied by procedure type where
foot and ankle procedures decreased in mean
adjusted reimbursement by 42.6. Hip fracture
procedures decreased by 31.9. Lower extremity
long bone procedures decreased by 30.9. Shoulder
and upper extremity procedures decreased by
23.7.
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Medicare Reimbursement for Orthopedic Surgery
Changing face of US healthcare system The US
healthcare system is very dynamic in terms of
policies and payment structures throughout the
last several decades, including Medicare. With
the aging of the population, there will be
increased demand on the Medicare system to fund
orthopedic trauma surgery and fracture care in
old people. Finally, to assure continued access
to high-quality surgical orthopedic care in the
US hospitals, Orthopedic surgeons, and
policymakers should understand the rising
healthcare awareness among the people and
changing reimbursement trends. If you are not
comfortable with changes and looking
for outsourcing partners for Medicare
Reimbursement for Orthopedic Surgery, then you
can contact us at info_at_medicalbillersandcoders.com
/888-357-3226.