A while ago, an acquaintance saw her dermatologist for an annual check. She said, “oh, by the way, take a look at the place on my foot where we removed a wart a while ago.” The doctor looked at her foot, said everything is fine, then finished the exam. Checking the bill, there was a $400 extra charge for the wart examination! This nice audio story from NPRs “third coast festival” tells the story of billing codes. Answer: As insurers and medicare/medicaid reduce payment for services, doctors respond by writing up every billing code they legally can. There are whole conferences devoted to billing code maximization. It’s a lovely unintended-consequences story. Good luck with that “cost control.” The piece quotes the Institute of Medicine that there are 2.2 people doing billing for every doctor, at a $360 billion dollar cost. I couldn’t find the source of these numbers. If any of you can, post a comment. Of course, being NPR, the program leaves the impression that all this will be fixed in our brave new world of the ACA. But it wasn’t even that heavy handed on the point. Perhaps experience is gaining on hope.
Video: Cheryl Bradley lectures on Medicare Billing
Doctors billing Medicare patients at higher rates, report finds
“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”
How doctors and hospitals have collected billions in questionable Medicare fees
Medicare has emerged as a potent campaign issue, with both Barack Obama and Mitt Romney vowing to tame its spending growth while protecting seniors. But there’s been little talk about some of the arcane factors that drive up costs, such as billing and coding practices, and what to do about them. Our 21-month investigation documents for the first time how some medical professionals have billed at sharply higher rates than their peers and collected billions of dollars of questionable fees as a result.
The Use of Electronic Health Records Is Increasing Medicare Billing: Is It Also Increasing the Amount of Care Physicians Provide?
Yet by focusing doctors on a particular checklist of items, EHR systems could also prevent physicians from considering problems that aren’t on the list. Standardization in medical practice is not always a good thing; today’s fringe treatment may be tomorrow’s gold standard. This type of standardization may be particularly unwise if it is done in the context of EHR systems, which may be focused on recording data that is important for billing or care coordination purposes rather than on reminding doctors about best practices. If this is the case, EHR systems may be nudging doctors to provide unnecessary care, which is the last thing our overburdened health care system needs. If EHR systems are actually changing the way doctors practice by providing standardized checklists and reminders, EHRs should be created with quality of care in mind.
Avoiding Claim Denials for Incorrectly Billed Influenza Vaccines for Medicare Beneficiaries
Medicare Part B covers 100 percent of the cost of one flu shot once every flu season with no Part B deductible or coinsurance required if you are a provider who accepts assignment. However, a beneficiary could receive the seasonal flu vaccine twice in one calendar year for two different flu seasons and Medicare would reimburse the provider for each. For example, a beneficiary could receive a seasonal flu vaccination in January 2012 for the 2011 – 2012 flu season and another seasonal flu vaccination in November 2012 for the 2012 – 2013 flu season and Medicare would pay for both vaccinations. Medicare may cover additional seasonal flu vaccinations within the same flu season if documentation shows medical necessity.
Justice Department Investigates Life Care Centers for Aggressive Medicare Overbilling
A few high-profile bankruptcies by continuing care retirement communities have made waves in the senior housing industry, and there’s more drama to come—for at least four more years, says a New York-based owner-developer of CCRCs who specializes in acquiring distressed assets. During Senior Housing News’ inaugural Senior Housing Summit, held last Thursday in Chicago, Ill.,… Read More »
HHS DOJ Letter on Improper Medicare Billing
On September 24, 2012, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) issued a letter concerning improper Medicare billing to the following hospital organizations; American Hospital Association, Federation of American Hospitals, Association of Academic Health Centers, Association of American Medical Colleges and the National Association of Public Hospitals and Health Systems. Electronic health records have the potential to save both money and lives, but the HHS and the DOJ have discovered indications that providers are utilizing the new technology in order obtain payments for which they are not entitled. The false documentation of care issues that they addressed are as follows: