Thousands of doctors and other medical professionals have added $11 billion or more to fees for elderly Medicare patients over the last decade by choosing to use more expensive billing codes and ignoring cheaper ones, a new study says.
The report "Cracking the Codes" from the non-profit investigative journalism organization Center on Public Integrity analyzed Medicare claims for a year and found thousands of providers "upcoding," which is "the practice of charging for more extensive and costly services than delivered, according to Medicare experts, analysis of the data and a review of government audits."
Controlling rising Medicare costs has been a hot topic in the presidential campaign. The center's report, which was released Saturday, suggested that reforms should start with a close look at the way hospitals and doctors submit bills for patient care.
For example, the study found that 7,500 doctors charged the two most expensive paying codes for three out of four visits in 2008, up sharply from the number who did so at the beginning of the decade.
The CPIs' report said medical groups argue that treating seniors has grown more complex and time-consuming because of new technology and because seniors are living longer.
But the report found little evidence that Medicare patients as a whole are older or sicker than in past years, or that the amount of time doctors spent treating them on average was rising.
Health care providers also said the rise in fees may be a reaction to years of under-charging, and that the higher costs reflect more accurate billing. The fees are based on a system of billing codes that is structured to make higher payments for treatments that take more time and effort.
Medicare regulators worry that the coding levels may be accelerating in part because of increased use of electronic health records, which make it easy to create detailed patient files with just a few mouse clicks, according to the report.
“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”
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