CMS acting administrator, Marylin Tavenner, is urging all Medicare Administrative Contractors (MAC) to develop a “Top 10” Hit list of physicians who provide Evaluation and Management Services (which is the vast majority of physicians in the Medicare program).
Physicians who treat sick patients who have complex diseases, who appropriately bill the highest level of E&M codes, are prime targets for the government’s new physician “hit list.”
The top 10 “high billers” for E&M services in every MAC jurisdiction can count on more scrutiny by the MAC, HHS OIG and increased Recovery Audit Contractor (RAC) attacks. Innocent physicians, who have coded correctly and who have committed no crime, will nonetheless suffer financial loss caused by the need to defend themselves against an unwarranted government attack.
The threat of imminent attacks for physicians who treat large numbers of complex sick patients, will provide a strong financial incentive for those physicians to downcode their E&M services so as to not incur the expense and stress of a possible government attack against their practices. Physicians who “voluntarily” forgo income by deliberate downcoding of E&M services will further exacerbate the problem for physicians who code high level E&M services correctly – the latter will be highlighted as “outliers” = “outlaws.”
So, the perverse incentive the government is creating by ramping up attacks against physicians who provide care to complex sick patients is to not take on too many complex sick patients lest they face financial hardship due to coerced downcoding or financial ruin due to a government attack.
Patients who have complex medical problems may find it increasingly difficult to find a physician who is willing to risk financial hardship or financial ruin of accepting them into a practice.
As the Medicare program moves toward financial collapse, we can expect more of these desperate “attack” policies by CMS in an attempt to delay financial collapse of the Medicare program.
The only safe strategy to avoid being a victim of an unwarranted government attack is don’t take the government’s money.
HHS IG Finds Increase In Physician Billing Of E/M Services.
Modern Healthcare (5/10, Daly, Subscription Publication) reports, “Rapid growth in Medicare spending on evaluation and management visits in recent years has been driven, in part, by fraud and more physicians billing for the most expensive types of those services, according to a report by HHS’ inspector general,” finding that “E/M billing grew by 48% to $33.5 billion by 2010 from $22.7 billion in 2001.” As a result, “Marilyn Tavenner, acting administrator of the CMS, wrote that her agency plans to urge each Medicare Administrative Contractor to review the top 10 high billers in their jurisdictions.”
Taken from: MSSNY Daily [email protected]
May 10, 2012
