COST CUTTING Some of your most common procedures, including colonoscopies, will be reimbursed at a lower rate in 2016.

You know that the physician cuts in Medicare reimbursement for colonoscopy and other lower GI endoscopy procedures are severe when you hear reports that gastroenterologists may reduce colonoscopy cases or even retire early because of them. But that's what we're facing this year. In the finalized CY 2016 Physician Fee Schedule rule, CMS cut reimbursement for several colonoscopy codes.

Mitigating the cuts
The colonoscopy code family — the highest volume code family — was hit hardest. Critics say the colonoscopy cuts are inappropriately deep and, at their highest, slash 2016 physician payment for some procedures by more than 17%. Though CMS's ASC cuts pale in comparison to the decreases we're seeing in physician payments, the dramatic reductions may also have a long-term impact on your colonoscopy screening volume.

On the facility side, the colonoscopy family is facing a 2.7% cut from last year, which averages out to be about $12 less per procedure. This includes all colonoscopy procedures coded 45378 through 45398, though colonoscopy with a stent (45389) and colonoscopy using ultrasound-guided fine needle aspiration (45392) will see big jumps in reimbursement this year.

One of the biggest drops includes proctoplasty procedures (45500 and 45505), which will drop 12.7% or an average decrease of $130. And while the sigmoidoscopy family saw a few increases, most of the codes in the category — including 45337, 45388, 45340, 45341, 45346, 45349 and 45390 — were cut about 7%, an average of $32 less per procedure.

While there are some increases this year, especially in upper endoscopic procedures, for the most part you'll be seeing cuts in reimbursement for your most common GI services. And while most of the drops are slight, you still may want to focus on minimizing costs and looking for additional opportunities to make up any missed revenue. Focus on increasing efficiency while ensuring that patient safety is still the No.1 priority. Improperly reprocessed flexible endoscopes continue to be a problem that can have devastating financial consequences, and one that has even shut down centers.

Lower GI Endoscopy Code Cuts
Below is a summary of the rate changes for commonly performed lower GI endoscopy procedures.

Source: American Gastroenterological Association

A good way to make up for the drop in revenue is to try to attract patients who aren't Medicare beneficiaries. Since screening colonoscopies starting at age 50 is the standard for preventative care, there are still plenty of patients with commercial insurance plans. Negotiate contracts with the big insurers in your area, if you haven't already.

Additionally, before scheduling any colonoscopy, make sure that you verify the patient's insurance and confirm with the referring physician's office whether the procedure is a diagnostic colonoscopy or a screening one. (A reminder: Screening tests are given in the absence of signs or symptoms, while diagnostic ones are tests performed as a result of an abnormal symptom.) Patients tend to have higher out-of-pocket costs with diagnostic colonoscopies, while a screening one is typically 100% covered by the payer. This is an important point to explain to patients before the procedure, so they aren't left angry and confused about any bills in the event a biopsy or polypectomy is performed.

The good news
There are a few bright spots in the 2016 fee schedule for ASCs. Centers will see Medicare reimbursement increases of 4.3% on average for upper endoscopy (EGD) procedures. A few notable ones include esophagoscopy biopsies (43202), which increased roughly 2% or about $8, and esophagus endoscopy repair, which increased roughly 4% or around $24.

There were also a few big bumps in the flexible sigmoidoscopy family, with code 45342 (sigmoidoscopy using endoscopic ultrasound guided fine needle aspiration) seeing a reimbursement increase of 105% this year, or an average of $475. CMS also bumped up rates for flexible sigmoidoscopy with a biopsy or a hot biopsy (45331 and 45333, respectively) by 1.8% this year, an average increase of $5. OSM