FAQ #16
       
Why does Trailblazer use a different point system?

Answer: Because they can. TrailBlazer is the Medicare carrier for VA, TX, MD, DE, D.C., and also for the Indian Health Service. Recently, this carier developed and deployed a completely new MDM point system to quantify E/M cognitive labor. This system is quite different from the standad MDM point system used by most other carriers.

Initially the new rules were quite draconian and required providers to work harder to qualify for the same level of MDM as providers in other states. Recently, they have relaxed the rules somewhat (these changes have not yet been updated on our website).

There was an unconfimred report that physicians in VA were so outraged by the new rules that they lobbied their medical society to pressure TrailBlazer to stop using the new MDM rules in that state. This issue is not addressed anywhere on the TrailBlazer website.

There is ongoing legitimate debate about whether individual carriers should be given the right to fragment the rules for a federally funded program which is supposed to be administered uniformly throughout the country.