Here are six takeaways from ProPublica‘s analysis.
1. In 2015, 1,825 health professionals charged Medicare for the most expensive office visits for established patients at least 90 percent of the time. This is compared to 1,807 health professionals who did the same in 2012.
2. Of the physicians billing Medicare at the highest level in 2015, 650 also billed at the highest level in 2012, according to the report.
3. Mark Roberts, MD, a family practice physician in rural Evergreen, Ala., billed Medicare for the highest-level office visits 95 percent of the time, more than any other U.S. physician. ProPublica‘s analysis of federal data found Dr. Roberts billed for 4,765 high-level visits in 2015 and collected about $450,000 from Medicare. Dr. Roberts did not respond to ProPublica‘s request for comment.
4. Dwayne Grant, a regional inspector general for evaluation and inspections for HHS in Atlanta, said while it is possible physicians may only treat the sickest patients and code for high-level office visits, “I don’t think it’s very probable. … We continue to believe that focusing on these high-coding physicians is going to improve oversight, reduce overpayments and really serve as a deterrent effect.”
5. In November, CMS issued a notice in the Federal Register stating guidelines for office visit billing date back to 1995 and 1997. The agency noted updating the guidelines could span several years.
6. Cyndee Weston, executive director of the American Medical Billing Association, told ProPublica it is “disappointing” upcoding remains a problem. Ms. Weston pointed to EHRs that assign billing codes when a physician clicks a box during an office visit as a potential culprit.
“Those programs tend to upcode,” Ms. Weston said. Should physicians copy and paste information about their patients’ care into an EHR that automatically assigns a billing code for a visit, “that is worrisome,” she said.
For the full ProPublica analysis, click here.
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