The Changes in Medicare Related to Gastroenterologists

Seems there’s never a dull moment in the life of a gastroenterologist. While it is crucial for professional gastroenterologists to outsource to medical billing experts to ensure that their medical billing is carried out correctly and under HIPAA compliance, there are many other areas that a gastroenterologist needs to focus on, such as choosing the right revenue cycle management system for their practice and keeping their finger on the pulse of the changing landscape of Medicare-related rules and regulations for gastroenterologists.

If you’ve been busy and unable to find the time to learn more about the latest changes in Medicare plans, then read on.

Why Should You Care?

Gastric bypass surgery, also known as Roux-en-Y gastric bypass, is one of the most common kinds of bariatric surgery. The good news is, this surgery is covered under the Medicare plan. However, gastric bypass surgery is covered under three conditions; previous unsuccessful attempts to lose weight, comorbid conditions, and having a BMI that’s 35 or higher.

It is important to note that while a gastric bypass surgery only costs around $15,000, those under Medicare only have to pay the standard cost. But, it is important to note that the cost may vary greatly, depending on various other factors, including where the surgery is performed. That said, compared to other kinds of bariatric surgery, gastric bypass surgery could possibly be the best option for people on Medicare – in terms of cost, at least. Those who meet specific criteria may be eligible for coverage for bypass surgery under Medicare.

Medicare covers both open and laparoscopic gastric bypass surgery, provided the patient meets the criteria mentioned above.

• Part A – This offers coverage at any hospital. The coverage includes hospital stay, medications, along with other medical expenses during your stay at the hospital.
• Part B –This offers coverage for any medical service you require for gastric bypass surgery, including post-surgery doctor visits. It also covers medications, laboratory tests, and durable medical equipment.
• Part C– this offers coverage for everything under the Medicare Part A and Part B plan. But this plan has its own set of rules that must be followed. As in, all providers need to be approved by Medicare.
• Part D –This offers coverage for prescription drugs, pain medication, and any other medication that is needed post-
• Medigap– This helps to cover out-of-pocket expenses of the surgery, such as copayment amounts, deductibles, and coinsurance.

Changes to Medicare in 2021:

• According to the revised Medicare plans, cuts to GI reimbursements could be about 4%, depending on the services of the practice.
• Due to budget neutrality regulations, this may not be reflected in payments for all E/M codes.
• Medicare proposes to maintain the current values for esophagogastroduodenoscopy (EGD) with biopsy (43239) and colonoscopy with biopsy (45385).
• Medicare proposes to increase the price for scope video system equipment (ES031) to around $70,000, which is also good news.

The above could be reasons why GI societies joined in a coalition of 65 societies opposing CMS’ latest decision. The GI societies also urged Congress to intervene on the matter.

Improvements for GI:

• CMS finalizes outpatient E/M coding changes. This can result in a significantly decreased documentation process.
• We will see major increases in GI scope equipment valuation. This includesspecialized equipment such as scope video system equipment to around $70k and suction machine equipment to around $3,100, which will be phased in two years.
• We could also see enhancements to colonoscopy codes (45385) and the value of EGD (43239).

Downsides of the Medicare Update:

On the flip side, there are some negative aspects of the revised Medicare payment plans. For instance, Medicare proposes to stop covering or paying for telephone evaluation and management (E/M) visits. According to reports, this new rule is going to be implemented as soon as the COVID-19 PHE expires. This is not good, mainly because telephone E/M has been vital for Medicare beneficiaries who do not have access to a smartphone and internet connection to access the E/M services they require.

But many saw this coming, especially since the agency has been pushing for the creation of a new code for audio-only patient interactions. This new code would be similar to the virtual check-in code G2012, with the exception that it would be used for a longer unit of time.

This is why, now more than ever, it is important for those who are looking for these services to find a plan that covers as many of the services related to gastric bypass surgery as possible. And to choose one that also limits out-of-pocket costs related to the gastric bypass procedure.

Gastroenterologists can fight back by visiting the official website of the AGA Advocacy Action Center and join the fight against CMS’s cuts to specialty care payments. Those gastroenterologists who are concerned about the outcome this can have on their medical billing can also use the AGA’s Medicare Physician Fee Schedule Calculator tool to determine the effect of the proposed cuts.

Ending Note

JBF Medical Billing, LLC. is an experienced and reliable billing service exclusively for Gastroenterologists and Gastroenterologist-related practices.Our medical billing software links easily to most of the EHR (electronic health records) software that physicians use. JBF Medical Billing LLC. is also a proud member of the American Gastroenterological Association (AGA), the American Association of Healthcare Administrative Management (AAHAM), and the American Medical Billing Association (AMBA), so you can rest assured all of your Revenue Cycle Management and HIPAA Compliance are taken care of by the experts.