Federal Policy
CMS Proposes 50% Cut to Same-Day Medicare Service Reimbursement
CMS has proposed a rule change that would reduce Medicare physician reimbursement by half for services provided on the same day as an office visit. The American Medical Association and more than 150 healthcare organizations, including the Oklahoma State Medical Association, are opposing the proposal. The proposed rule affects Medicare payment policy for same-day services. If finalized, the reimbursement reduction would impact physician revenue and potentially service delivery patterns.
Why it mattersWhile this is a Medicare payment policy change, Medicaid managed care plans often benchmark provider reimbursement to Medicare rates, meaning state agencies and MCOs may face provider network stability concerns if similar methodologies are adopted or if Medicare cuts reduce provider participation more broadly.