Health & Fitness
Wall Street Journal says doctors pad Medicare fees by $11 billion or more
The codes have five numbers and start with a "99"
The Wall street Journal of March 10 quoted an investigation by the Center for Public Integrity and wrote:
"Medicare allows doctors to pick from among five different codes to bill their services, from a low number for a simple visit to a higher number for a complex visit ... From 2001 to 2010 billing the higher codes padded practitioners' fees by $11 billion or more."
As we have written before, a level 4 office consult is apparently charged in <a target=new href=http://emuniversity.com/Level4OfficeConsult.html>49% of encounters</a>. It requires a comprehensive history, comprehensive exam and moderate complexity medical decision making. Or, if you base it on accounting for doctor time, 60 minutes spent face to face.
Yet we typically see the doctor for 5-15 minutes! Let's do the numbers. Medicare cost are $500 billion per year, out of a total health care cost of $2.8 trillion. If the Medicare fraud from office visit coding is $11 billion, this would imply that the total amount of fraud from charging office visits at an inappropriate fee, whether it is Medicare or not, is $62 billion.
A lot of money!
Most of us know nothing about these codes so here is some information:
The codes have five numbers and start with a "99" and end with a 1,2,3,4 or 5. 1 is the shortest visit and 5 is the longest visit. Between the 99 and the last digit there is "21" if it is an established patient, "41" if it is a referral by another doctor etc. When you get your doctor's statement you can type the code into Google and you will find out at what complexity the visit was charged at.
Chances are pretty good that your doctor padded your bill. Bring a stop watch next time you go.
