Excerpt
HARI SREENIVASAN (Newshour): The new report looks at hundreds of thousands of bills from doctors, hospitals and medical professionals over a decade.
Doctors bill the government for a Medicare patient's visit by using one of five codes, each one at a different rate. The investigation found doctors are increasingly charging Medicare at the higher rates for routine visits, a practice known as upcoding.
The Center for Public Integrity found those charges and others may have added at least $11 billion to the government's tab over 10 years, even though many of the higher billings seemed questionable. And the report comes amid greater political attention on lowering Medicare costs.
Fred Schulte is a senior reporter with the Center for Public Integrity, an investigative reporting association. He joins me now.
COMMENT: While the conclusion of the report is likely true, there is another possibility. Note, that the 'codes' used are NOT defined by Medicare, they are defined by the health care insurer or plan.
I had a coworker at the San Diego division (home offices are in Alabama) that had one of the two company healthcare plans, both national. Her health care plan card was accepted in San Diego, and her card stated that the plan was Alabama. The problem she always faced was the codes for her health care plan used by the California region were NOT the same as the codes used by the Alabama region. She had to fight to get a procedure or drug, provided in San Diego, approved for payment by Alabama just because the codes were not the same.
In the context of the article, the "upcoding" MAY be the fault of the bureaucracy of the health care insurance industry, not individual doctors.
As to the interviewee's comment on increased inspections being a burden on doctors, BS. The system should be fully computerized and sending 'documentation' is just a mouse-click.
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