Issue does not directly affect clinical laboratories and pathology groups, but puts spotlight on some hospitals and physicians who frequently use these codes.
Could increased use of electronic health records (EHR) systems be causing more hospitals and physicians to commit fraud because of upcoding? That’s the assertion of certain federal health officials. They attribute the increased proportion of Medicare claims for more complex and more expensive services by some providers to be, in some part, acts of fraud.
Most pathologists and clinical laboratory managers will notice the irony in these allegations that providers are upcoding services to Medicare patients in fraudulent ways. After all, the federal government is currently paying billions of dollars in financial incentives to encourage providers to implement and use certified EHR systems with the goal of lowering healthcare costs, while improving patient outcomes.
OIG Audit Findings Are Source of Fraud Allegations
Insinuations of provider fraud came after the public learned of findings of an audit done by Health and Human Services’ Office of Inspector General (OIG). The OIG determined that payments for more complex Level 5 E/M services increased by 21% between 2001 and 2010. During that same period, payments for medium-complexity patient services decreased by 11%.
For all of 2010, the Centers for Medicare and Medicaid Services (CMS) paid out $33.5 billion for E/M billings. This was about one-third of Medicare Part B payments for physician services. These numbers were part of a story published in Modern Healthcare.
Now that much larger numbers of physicians and hospitals are using electronic health record (EHR) systems, Medicare has noticed a steady increase in the proportion of claims submitted at higher and more complex codes, increasing reimbursement. In response to one federal government audit, Kathleen Sebellius, Secretary of Health and Human Services (r) and Attorney General Eric Holder (l) held a joint press conference to announce to healthcare providers that there would be stricter audits of providers who are using billing codes for complex patient visits with greater frequency. (Photo by Manuel Balce Ceneta, copyright Associated Press.)
As they hire young pathologists, pathology groups and clinical laboratories will need to factor in the generational preferences of these Gen Y physicians
Generation Y doctors take a much different approach to the practice of medicine than the Gen X and Baby Boomer doctors who preceded them. It will be important for clinical laboratories and pathology groups serving Gen Y physicians to understand these important differences.
While Gen Y doctors remain just as dedicated to the high standards of medicine as their predecessors, the current crop of young doctors approach the practice of medicine with a much broader world-view than previous generations of physicians, according to a recent story in Modern Healthcare (MH). (more…)
Younger Gen X and Gen Y pathologists have different workplace expectations
Aging Baby Boomers are about to retire and double the nation’s population of senior citizens. Meanwhile, a decline in the pool of practicing physicians-the majority of which are part of the Boomer generation-has put the United States on a collision course for the gravest shortage of physicians in our nation’s history.
For medical laboratories, these demographic trends will change the way labs hire, compensate, and retain pathologists. Cejka Search , a St. Louis firm specializing in physician recruitment, recently issued a report on physician recruitment. Among other things, Cejka Search states that the physician shortage has already created tremendous competition among practices for young doctors. In turn, these young doctors demand more in compensation and perks because they can.