Medicare providers say they lose millions due to excessive audits

Health care providers say they're losing millions that are tied up in appeals because of the increasing number of Medicare audits. Meanwhile, the trade group representing family physicians complains about Congress' failure to fix Medicare's outdated physician payment formula.

The Associated Press: Medicare Providers Complain Of Duplicative Audits
Health care companies say they're losing millions of dollars that are tied up in appeals because of increasing numbers of Medicare audits. But the rise in the often duplicative audits has failed to reduce Medicare fraud, according to a report released Wednesday. In recent years, the Obama administration has added manpower to investigate cases, increase audits and analyze more data to fight fraud in the taxpayer-funded Medicare program. Yet a report from the U.S. Senate Special Committee on Aging criticized the government for not targeting its resources more effectively (7/9).

Kansas Public Radio: Kansas-Based Physicians Group Unhappy With Medicare Payment Plan
The American Academy of Family Physicians, based in Leawood, has some issues with the Centers for Medicare and Medicaid Services' recently released Medicare physician fee schedule for 2015. But the doctors' group blames Congress more than CMS. The biggest issue is the so-called sustainable growth rate formula, which Congress enacted in 1997 to hold Medicare spending at or below the U.S. economy's growth rate. To comply with the law, CMS proposes reductions in the reimbursement rate for doctors every year. And every year, Congress suspends those cuts. Next year's reduction in physician fees would be 20.9 percent. Tennessee physician Reid Blackwelder, who serves as president of the American Academy of Family Physicians, said if that cut is allowed to take effect, some doctors may have little choice but to stop seeing Medicare patients (Thompson, 7/9).

Kaiser Health News: Capsules: CMS May Soften Paperwork Requirements For Home Health Care
Doctors may not have to write a narrative summary for patients needing home health care if a proposed rule by the Centers for Medicare and Medicaid Services is finalized. For Medicare to pay for a home health visit, which includes physical therapy, speech therapy and skilled nursing care, the patient must be seen by a doctor either 90 days prior to the start of the home health care or 30 days after the start of the services. Currently, Medicare also requires that physicians certify that these patients are under their care and that they have trouble leaving home without the help of a walker or special transportation because of an illness or injury. To do so, doctors have to fill out what's referred to as a face-to-face document, which states when the doctor saw the patient, and includes a narrative summary stating why the patient is homebound (Gillespie, 7/10).

http://www.kaiserhealthnews.orgThis article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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