Doctors billing elderly Medicare patients by disregarding less expensive billing codes

By Catholic Online (NEWS CONSORTIUM)
9/18/2012
Catholic Online (www.catholic.org)

Study finds that thousands of providers are 'upcoding,' charging for costly services

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.

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.

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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."

� 2012, Catholic Online. Distributed by NEWS CONSORTIUM.

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Keywords: Upcoding, medical billing, senior care, Medicaid

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1 - 6 of 6 Comments

julieanderson
3 months ago
There is lot of scope to get in to the medicare fraud very easily as it is more costly and people are more liberal in this as it comes under medicare criteria!!
http://www.medicarerhodeisland.com/
carolyn
8 months ago
Doctor offices do this all the time. I have seen it on bills for the pediatrician I take my kids to. They use codes that would allow for more expensive billing and medical equipment I never received. I have been in contact with my insurance company for the last 6 months. I have not paid the bill. Every time I receive a bill from the doctor, I call the insurance company, then I call the doctors office. I don't think it is a billing error like they say. They know exactly what they are doing. They will use whatever code they can to get the most out their patients. I don't trust them when it come to my billing. It is the doctors that tells their staff what kind of care a patient receives and what codes apply. My doctors office even stopped giving us discharge papers with diagnosis codes. They don't want their patients to have that information. The problem is not only with the older population, it is all across the board. Health care costs are going up, because over billing is driving costs up. I have had a credit at my doctors office and they won't tell me. I end up paying my copay when I shouldn't have to. I have found out that you have to be very specific when asking billing questions. They won't tell you have a credit.
Lu Hernandez
8 months ago
I am finding this article disturbing. Specifically the assertion that as a whole patients are no older or sicker than in the past. I work for a gastroenterologist in a primarily Asian immigrant community. These patients are entering the country extremely ill. Due to the unhealthy conditions in their native countries, they suffer from liver and digestive diseases. I personally have provided information to Medicare regarding the coding on many of our patients and Medicare has not found any problems with our coding. Perhaps the problem is in the written Medical records that physicians are providing to Medicare. Many physicians are not familiar with the many Medicare requirements in providing their progress notes. In closing, I think we need to hear the other side of the issue, a doctor's perspective before we can judge if indeed this article holds any weight. Thank you for your attention.
DENISE M. SHARAR
8 months ago
everybody needs to be more honest or we are going to be in trouble next. how many times do i have to tell people that GOD NEVER MISSES ANYTHING. BE HONEST!
Kasoy
8 months ago
If you know government is going to pay the bill, you have the tendency to overcharge simply because government can afford to pay for it and will pay for it. Patients are not going to "shop around" for cheaper doctors or hospitals since government will pay their bills. Whenever you take competition out of the economic activity, monopolistic pricing is the result - high price, low quality products or services.
chris
8 months ago
The reason we wound up with managed health care to begin with is because doctors were gouging the system. Doctors are no longer happy to make $100,000 or even $200,000. Everyone now is shooting for millions and to be billionaires.

No one ever talks about how the doctors abuse the system by overbilling for things My 89 year old father was in the hospital for palliative care and he got every test imaginable. The doctors are around for only 5 minutes and you are chasing after them and if you are lucky, you get 3 questions answered. Everyone at the nurse's stations are trained to say nothing but "you have to talk to the doctor".

This hero worship that these doctors live under is part of the problem.

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