Medicare to Release Physician Payment Information

On April 2, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced its intent to publish data on its payments to individual physicians. Beginning on April 9, 2014, CMS plans to release information regarding the charges for medical services and procedures furnished by physicians and other health care professionals.

CMS stated that the data on the types of medical services and procedures furnished by physicians will be organized by National Provider Identifier (“NPI”), Healthcare Common Procedure Coding System (“HCPCS”) code, and the place of service (i.e., whether the services were furnished in a facility or office setting). The data to be released include:

• The number of services performed at each NPI/HCPCS code/place of service;
• The average submitted charges and standard deviation in submitted charges;
• The average allowed amount and standard deviation in allowed amount;
• The average Medicare payment and standard deviation in Medicare payment; and • A count of unique beneficiaries treated.

CMS claims that the information would give the public a better picture of how physicians practice in the Medicare program. CMS also stated that the information will assist the public in understanding Medicare fraud, waste, and abuse. In a letter to the American Medical Association (“AMA”), CMS stated that the increased transparency will help patients make informed decisions about the care they receive.

However, many assert that the information could easily be misinterpreted. For example, Medicare pays different rates for services in different cities and regions, which may not be clear to those lay persons viewing the information. Doctors may also charge higher rates for complex patients, or when there are extenuating circumstances. Some doctors also see a higher number of patients with Medicare, necessarily resulting in higher overall billings to the program.

In a statement, AMA president Ardis Dee Hoven, M.D., said: “The AMA is concerned that CMS’ broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers.” To help curb misleading information, Dr. Hoven stated that “the AMA strongly recommended that physicians be permitted to review and correct their information prior to the data release.”

For more information on this topic, you can reach Abby Pendleton, Esq. at apendleton@thehlp.com or Jessica Gustafson, Esq. at jgustafson@thehlp.com. Pendleton and Gustafson lead the firm’s Medicare Audit and Appeals Department.