No Free Rein to Bill Whatever You Want
Written by Editor   
Thursday, June 05, 2014 07:22 AM

And in the category of "you can't blame the chiropractors for that"… "The challenge that CMS is trying to figure out is what is the best way to get at this. This is not just free rein to bill whatever you want."

Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a new report from the inspector general of the U.S. Department of Health and Human Services.   The inspector general's report estimates that overpayments account for 21 percent of the $32.3 billion spent on evaluation and management (E&M) services in 2010. The E&M category includes office visits, emergency room assessments and inpatient hospital evaluations.

This is the second time that the inspector general has singled out this area for more scrutiny. In 2012, the watchdog said physicians had increasingly billed Medicare for more intense -- and more expensive -- office visits over time.  "The natural question that comes out of this is: are these physicians billing appropriately?  But in its reply to the findings, the Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most-expensive visits because it isn't cost effective to do so.  

Overall, more than half of the claims were billed at the wrong rate or lacked documentation to justify the service. Sometimes physicians billed for a lower-cost service than the one they delivered, but more often they billed for a higher-cost one.

In its report, the inspector general's office recommended that CMS educate doctors about proper billing practices.  It also suggested that Medicare pursue doctors who consistently billed for higher-level services than they actually delivered, a practice known as upcoding.

While CMS agreed with the need for education, it disagreed with the recommendation to review the physicians' billings. It said one of its contractors recently reviewed 5,200 medical claims of high-coding physicians and the process cost more money than it caught in overpayments.

"The challenge that CMS is trying to figure out is what is the best way to get at this. This is not just free rein to bill whatever you want."

Source:  http://www.medpagetoday.com/PublicHealthPolicy/Medicare/46041