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Doctors billing elderly Medicare patients by disregarding less expensive billing codes

By Catholic Online (NEWS CONSORTIUM)
September 18th, 2012
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An investigative journalism organization says that thousands of doctors along with other medical professionals have added a strapping $11 billion -- or more to fees for elderly Medicare patients over the last 10 years. The method, described as "upcoding," is derived from the active choice of using more expensive billing codes and ignoring cheaper ones.

LOS ANGELES, CA (Catholic Online) - The report, entitled "Cracking the Codes" from the non-profit organization Center on Public Integrity analyzed Medicare claims for a year. The group found many egregious examples of "upcoding."

Rising Medicare costs has been a "hot button" in the presidential campaign. The report, released over the weekend suggested that reforms should start with a close look at the way hospitals and doctors submit bills for patient care.

The study found that 7,500 doctors charged the two most expensive paying codes for three out of four visits in 2008.

In their defense, medical groups argue that the medical care of seniors has grown more complex and time-consuming due to the new technology and because seniors are living longer.

However, 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.

The rise in fees may also be reactions to years of under-charging, medical officials maintain, 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.

Coding levels may in fact 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, the report concludes.

"This is an urgent problem," Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, says. 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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