Anesthesia Billing & Management

A Senate bill, introduced by Senator Charles Grassley (R, Iowa), is looking to trim Medicare fraud. In the process, physician billing data would be published online, irking doctor privacy advocates.

The bill would allow people to see how much doctors earn each year from the program. The data has been kept private by a court ruling for more than 30 years. Lawmakers are looking to lift the ban in order to bring Medicare billing data public in an effort to prevent fraud.

The measure was presented to a Senate Finance Committee hearing on Medicare and Medicaid fraud on March 2, 2011. Part of the bill’s requirements would be that the Deptartment of Health and Human Services starts to publish Medicare claims and payment data on the website USAspending.gov by the end of 2012.

According to Senator Grassley, making the data public could save billions each year in taxpayer dollars.

"More transparency about billing and payments increases public understanding of where tax dollars go," Grassley said. "The bad actors might be dissuaded if they knew their actions were subject to the light of day."

Oregon Senator Ron Wyden (D) has said that he is drafting his own legislation that would make Medicare claims data available to the public.

On the other side of the argument you have the American Medical Association who says that only bad can come from publicizing the records and that those who monitor fraud already have access.

"Releasing Medicare claims data to the public does not further the goal of combating fraud, as those tasked with this responsibility already have access to the data," said Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.

CMS, or the Centers for Medicare & Medicaid Services, set a goal to cut the Medicare fee-for-service error rate in half by 2012. According to a CMS official’s testimony in front of Congress, they are seeing progress towards that goal.

According to Deborah Taylor, CFO and director of the CMS’s Office of Financial Management, the error rate fell by nearly two percent from FY 2009 to FY 2010. Their goal is to cut the error rate from 12.4 percent to 6.2 percent by 2012.

Taylor testified alongside Health & Human Services Inspector General Daniel R. Levinson in front of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies on March 17.

"We recommended that CMS take several actions to address these errors, including improving controls, educating providers and clarifying guidance," said Mr. Levinson in regards to the collaboration between CMS and HHS on developing methods of detecting and stopping payment on claims errors.

Ms. Taylor said the agency has installed automated safeguards for this year that could detect and reject payments for "medical services that are physically impossible, such as a hysterectomy billed for a male beneficiary."

She does caution that some errors can’t be corrected through automated means and that they need to be further reviewed and be susceptible to other means of correction.

The Centers for Medicare & Medicaid Services expects to process 1.2 billion Medicare claims in 2011.

With the help of a Senate Finance Committee, a bill has been passed to freeze Medicare reimbursements at current levels for another 12 months. The U.S. House of Representatives passed the Medicare and Medicaid Extenders Act of 2010 on December 9.

The bill, which is effective January 1, 2011, will eliminate the 25 percent cut in reimbursements that doctors would have faced. Needless to say, doctors are happy with the move, even if it only solves the issue for another 12 months.

"Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors’ access to physician care in 2011," said Dr. Cecil Wilson, president of the American Medical Association.

The House vote was nearly unanimous, at 409 to 2. President Obama just has to sign the new law and it will take effect, and since he was already a champion for the cause, that should not be an issue.

This is also good news for elderly patients, since some doctors have said that the dwindling Medicare payments and a further cut would have meant that they could no longer see new Medicare patients. In fact, surveys have shown that up to 43 percent of doctors who see Medicare patients would stop seeing them if the pay cut would have gone through.

"One of our top priorities next year will be to make (the fix) permanent, so our seniors can find doctors," said Rep. Wally Herger, Republican from Chico, Califnornia.

The only two in the House to vote against the bill were Brian Baird (D, WA) and Tom McClintock (R, CA-04).

Lawmakers have faced this same issue every year since the ’90s. But every year they "kick the can" ahead, so to speak.

"The fix is helpful," said Tricia Neuman, a vice-president of the Kaiser Family Foundation and director of its Medicare Policy Project. But "similar problems will resurface next year because the underlying sustainable growth formula for physician payments has not been reformed."