Feds ease hassle factor but not get-tough stance
Feds ease hassle factor but not get-tough stance
Providers’ complaints may be paying off
You might think Christmas came early this year. Over the past several weeks:
— The Health Care Financing Administration (HCFA) began spending $4 million on a crash program to install a toll-free number it wants up-and-running by summer. Physicians will be able to call with their questions about Medicare payment rules.
— HCFA Administrator Nancy-Ann DeParle has promised Capitol Hill she will "directly contact" all physicians, home care providers, and durable medical equipment suppliers participating in Medicare to address common documentation problems and billing errors. The agency also plans to help educate providers about satellite broadcasts and computer courses on proper claims filing and documentation, among other things.
— The Office of the Inspector General (OIG) has released an open letter saying providers who voluntarily step forward and disclose any billing errors and reimbursement problems before investigators find out about them can expect federal gumshoes to go easy on them.
— Medicare also says it soon will begin testing another set of possible revised guidelines for documenting evaluation and management services.
All those moves are a part of a renewed effort by HCFA to reach out to providers who feel increasingly abused and set up as cardboard bad guys by overzealous auditors who can’t tell the difference between a simple billing error and outright fraud.
"They’re wasting an awful lot of money harassing honest doctors," says John A. Bennett, MD, a Sequim, WA, family practitioner. "We’ve dedicated our lives to this profession, and we’re being treated like common thieves." In frustration, Bennett recently dropped out of the Medicare program.
Many experts say the dropout trend will continue. "Medicare hassles and overly aggressive billing audits are souring physicians on the Medicare program, which will only make it more difficult to provide the best medical care for seniors," American Medical Association immediate past president Nancy W. Dickey, MD, told the Senate Appropriations Committee recently.
Last March, the OIG issued its annual audit of Medicare payments covering the 1999 fiscal year. It found that out of 5,223 claims reviewed, 1,034 did not comply with Medicare laws and regulations. According to the audit, improper Medicare payments during fiscal year 1999 totaled $13.5 billion — $1 billion more than in fiscal year 1998, an increase the OIG admitted was statistically insignificant.
Although that was nearly half the $23.2 billion in improper payments estimated for 1996, the new figure is "unacceptable," says U.S. Sen. Tom Harkin (D-IA). "We’ve slipped. The steady progress has stopped."
Inspector General June Gibbs Brown’s attitude is that federal officials "have resolved a lot of easier problems and now are at a point where it will take some intensive work."
What to focus on
Based on the kinds of errors identified in the OIG’s audit, here are some areas where practices can expect more attention from claims inspectors:
• Poor documentation. Claims with no or insufficient documentation were the largest source of improper fiscal year 1999 Medicare payment payments ($5.5 billion) identified by the OIG.
• No medically necessity. $4.4 billion in claims were ruled not medically necessary by a carrier or peer review organization.
• Incorrect coding. $2.1 billion were spent on incorrectly coded Medicare claims.
• Noncovered services. $1.5 billion were paid for services not covered by Medicare.
"These improper payments range from inadvertent mistakes to outright fraud. The amount of fraud is likely very small, although the government has no way to actually measure it," notes Brown.
In fact, government officials do not know how many of the 900 million claims paid by Medicare annually are the products of outright fraud such as phony records, kickbacks, or billing for services that were never performed. "We cannot quantify what portion of the [improper payment] error rate is attributable to fraud," Brown told a House hearing on Medicare fraud.
According to American Osteopathic Association (AOA), the primary reason for the error rate is confusion over complex Medicare rules. "Frequently, what is being classified as fraud is actually billing errors that result from complicated regulations and burdensome paperwork," the AOA told the Senate.
HCFA’s DeParle admits Medicare regulations can be complex, but she insists that providers are not being prosecuted for inadvertent errors.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.