Starting on Jan. 5, 2015, interventional cardiologists can take advantage of one of the most important advocacy opportunities available: the option of being identified by payers, including Medicare, not as general cardiologists or as internists, but as interventional cardiologists. Taking this step – which requires completing some relatively straightforward paperwork amounting to about 15 minutes of your time – should result in
Why? Because by convincing the Centers for Medicare and Medicaid Services (CMS) to recognize interventional cardiology as its own specialty, rather than combining it with general cardiology, SCAI has changed the landscape for interventional cardiologists who designate themselves by their own specialty. Here’s how:
Fewer Claims Denied
Now, when a general cardiologist and an interventional cardiologist from the same practice both participate in a patient’s care, they both can be fairly reimbursed for their own, distinct work, without concerns about duplicate claims. This is because the work of each physician can be recognized for its unique value to the patient.
Fairer Comparison of Resource Utilization
The separate designation code for interventional cardiology will also address serious concerns about apples-to-oranges physician comparisons. Before the addition of the new specialty code, interventional cardiologists were grouped with general cardiologists, internists and other less-intensive physicians in payers’ administrative databases. The interventionalists’ resource utilization naturally skewed toward the high end of the curve without explaining why. Using the interventional cardiology designation will help ensure that these scores are like-for-like comparisons with other interventionalists.
Improved Evaluation of Performance and Outcomes
In the absence of an interventional cardiology designation, the outcomes of interventionalists’ patients have been compared with the outcomes of patients of non-invasive cardiologists or internists. There has been no mechanism for recognizing that interventionalists’ patients were often sicker or required more complex treatment. In these scenarios, interventional cardiologists’ quality-of-care performance scores may have been negatively impacted, potentially influencing their quality of care scores, which are often used by patients choosing a physician, trial attorneys in litigation, hospital administrators determining new hires and journalists covering health care. By eliminating these apples-to-oranges comparisons, the new interventional cardiology designation levels the playing field and potentially improves public perception of the specialty.
Better Data and Enhanced Advocacy
Finally, the new interventional cardiology designation will allow for more accurate data on the total number of interventional cardiologists and interventional procedures in the United States as well as more accurate aggregated performance scores. This more reliable information will help SCAI to clarify its advocacy platform with policymakers, yielding a better regulatory environment for the field.
NEW! How to Designate Interventional Cardiology as Your Specialty
Note: The designation process will continue to evolve as CMS implements online options. SCAI will keep you informed of changes to this process.
Steps for Designating Interventional Cardiology
- Go to http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855i.pdf, and download Form cms855i for “Changing Your Medicare information.”
- Complete this form. The key field is on page 7. In response to “d.1 Physician Specialty,” be sure to check “Undefined physician type (specify)” and then enter “P-interventional cardiology.”
- Submit a hard copy of the completed form to your local Medicare Administrative Contractor.
- When you submit this form please notify SCAI’s Director of Reimbursement & Regulatory Affairs, Dawn R. Gray at dgray@SCAI.org with member's name, contact info and Medicare number. SCAI will be tracking enrollment numbers to ensure that national and local records match.
- File a copy of the completed form for your records.
Need help? SCAI’s Director of Reimbursement & Regulatory Affairs, Dawn R. Gray, can be reached at dgray@SCAI.org.