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Blog: Study finds providers billing at higher rates

Later this week, the nation's hospitals and physicians will launch another round of ads in Washington-based publications to warn Congress of the disastrous results that will come from cuts to Medicare early next year. Meanwhile, an investigative study from the Center for Public Integrity shows one way hospitals and doctors are coping with the tough federal reimbursement environment: steadily billing higher rates for treating Medicare patients in the last 10 years.

Established in 1989, the Center for Public Integrity is a nonpartisan, not-for-profit, investigative news organization. In its new study, the center found that from 2001 through 2010, thousands of providers chose more expensive billing codes over less costlier ones, even though “there's little hard evidence they spent more time with patients or that their patients were sicker and required more complicated—and time-consuming—care.”For instance, in 2008, more than 7,500 physicians billed the two top-paying codes for 3 out of every 4 office visits that year, which reflected a considerable increase from the number of physicians who did so at the start of the 10-year time frame. All told, the report found that the higher billing rates added about $11 billion more to their fees and suggests medical billing abuse. Interestingly, that's about the same amount that's expected to come out of Medicare provider payments under the debt-reduction details the White House released late last week.

And I think this finding is especially worth noting: “Medical administrators have struggled for more than a decade to crack down on medical coding errors and abuses, often in the face of opposition from medical groups including the American Medical Association, which helped design, and now controls, the codes,” the results noted. “Whether they make honest mistakes or engage in willful misconduct, there's little chance doctors who pad their charges will face any serious penalties.”

"Any suggested linkage between AMA stewardship of CPT and an upswing in reporting more intensive medical services is unfounded. CPT is a nomenclature – a listing of descriptive terms and identifying codes for reporting medical services," AMA President Dr. Jeremy Lazarus said in a statement. "CPT provides a uniform language to describe medical services, allowing nationwide communication among physicians, patients and payers. The AMA provides guidance for the appropriate use of CPT, but does not profit in any way if physicians bill an insurer for a complex service rather than a simple service. The AMA does not receive a single taxpayer dime for the use of CPT in the Medicare and Medicaid programs."

The Chicago-based AMA joined the American Hospital Association and the American Nurses Association in the ad campaign that cautions more than 766,000 healthcare and related jobs could be lost (PDF) by 2021 if the Medicare sequester takes effect starting early next year.

What are your thoughts about the new report, or the ad campaign from the three provider groups? Let me know: jzigmond@modernhealthcare.com.



You can follow Jessica on Twitter @MHJZigmond.
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