Healthcare executives often forget that those who fail to hang together, hang separately. And with Columbia/HCA Healthcare Corp. under the scrutiny of the government and mainstream media organizations, there's a disconcerting note of smugness in the air among Columbia's critics and competitors.
Many of these execs see Columbia as the enemy and are finding it hard to resist the temptation to say "I told you so" as HHS, the Justice Department, the FBI, the New York Times, the Wall Street Journal and "60 Minutes" have taken turns hammering Columbia.
In particular, the glare of publicity over upcoding practices of the nation's largest for-profit healthcare provider should be no cause for celebration. A recent Wall Street Journal article described upcoding of medical services covered under Medicare as a major hospital "sport." The report of providers working aggressively to game the Medicare payment system probably startled many who are unfamiliar with the arcane science of reimbursement for medical services.
Industry observers, however, know Columbia's coding practices are not unique. A continuing series of unrelated but similar problems in billing for outpatient lab tests has become a major HHS target as investigators from the inspector general's office focus on Medicare billing fraud. A recent Medicare fraud alert issued to investigators detailed the practices of coding consultants employed by hospitals to help the facilities upgrade the seriousness of ailments to get higher reimbursements.
Energetic efforts to obtain liberal Medicare payments are not illegal or even unethical. But with the government seeking to cut every dollar it can from the federal budget, pressures will mount to rein in abusive practices in the $200 billion Medicare program.
Executives who don't want to be embarrassed by coding fiascoes must be able to justify the procedures their staffs have put in place to obtain reimbursements. The bottom line is to bill exactly for what you do, and make sure you do exactly what you bill for.