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Docs deserve pay for cognitive skill set

Docs deserve pay for cognitive skill set

In today’s healthcare environment, physicians are compensated for the volume of services rendered as well as ancillary services (MRI, PET, CT, catheterization, and other test orders).

But shouldn’t physicians also be adequately reimbursed for their cognitive services? Why are physicians not paid properly to use their brains to solve clinical issues and problems for their patients? After all, that’s what they are trained to do.

What would constitute cognitive services (see Table 1)? Chronic disease care management, Table multidisciplinary coordination with other physicians relative to patient care, and participation in tumor board conferences and cancer committees are some examples. Also: ongoing pain management, phone calls related to patient care, and pharmacy management.

While these activities relate directly to patient care and management, they are not currently billable. Specialists often bill at the same rate as primary care physicians when they should be able to bill a Level IV or Level V for the complex management of their patients.

Unfortunately, during the last round of changes to reimbursement, the Centers for Medicare and Medicaid Services (CMS) did not add enough physician cognitive value in the new codes.

When Congress passed a bill that reduced ancillary drug payments, CMS tested a model that eliminated profits from ancillary services. The agency then added physician value and extra overhead costs to the new oncology codes. This model was adopted by the American Medical Association in 2005.

While CMS claimed considerable cost savings with this model, cognitive services were not taken into account. CMS continues to audit physicians who document and bill the highest level of visit codes.

A simple solution

Solving the cognitive services problem is simple. The answer lies with the development of three new specific codes that would require face-to-face contact, but would still recognize cognitive services, by all specialist physicians, for the care and management of chronically ill patients.

This solution would enable patients to receive the quality care they deserve. As an added bonus, perhaps physicians would be less likely to order unnecessary, high-cost ancillary services as a means of boosting income.


Marty Neltner, a nationally recognized billing & coding expert, has testified numerous times before Senate subcommittees and the AMA on issues concerning the practice of oncology. Mr. Neltner is the founder and president of Neltner Billing and Consulting.
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