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CMS Billing Rules Subjugate Family Medicine – No Payment for Convenient Care

June 23, 2014

I’m continuing my series on the reasons there are so few family physicians in the U.S. and why the Center for Medicare and Medicaid Services (CMS) is a root cause of this deficit. My conclusions are based on recent research on the topic.

Have you ever wondered why doctors tell you to come in and see them when you call them with relatively simple needs? Imagine you had bladder infections before in your life, and all signs suggest that you are developing a new case. You call your doctor to see if you can get some antibiotics that worked well in the past. Your doctor refuses to just call them in and insists you come to the office, where he talks to you briefly, barely examines you, and finally writes a prescription and gives you a standard office bill. You can blame CMS for this.

I really wish I could provide this service for patients and keep my office open and viable, but I can’t. CMS rules say a physician cannot bill without a face-to-face encounter. This completely takes off the options of telephone visits or e-mail visits. I don’t think family physicians need to charge much for these encounters. $30 or so would probably be sufficient, which is a lot less than what I’d charge for an office visit.

And practically all of the insurance companies have the same policies, because they just blindly follow CMS rules.

If you want to be treated better and have your time and travel better respected by the healthcare system, talk to your company’s Human Resources people about actually innovating to a disruptive degree, and pay your family physicians for the convenience you’d like to experience. And tell your Congressperson to dump the existing CMS evaluation and management rules. There are so many better ways for family physicians to care for their patients.

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One Response to CMS Billing Rules Subjugate Family Medicine – No Payment for Convenient Care

  1. Tracie Updike on June 24, 2014 at 8:40 am

    Said but true! Since I am self employed and if it is to be it is up to me. I will call in scripts for patient with easy stuff only if you have been in the office within the last three months and you have had this problem before.

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