Monday, October 05, 2009

Another reason for internists to not participate in Medicare-Medicare Recovery Audits

The Medical Recovery Audits system has designated various contractors to execute this program to audit physician's practices searching for errors and overcharging.See here for CMS 's description of what is in store and what has happened so far with this program.

The auditors will use Part B claims data to identify what they will decide are underpayments and overpayments (don't expect to find a lot of those). Medical records will be "requested" from physicians. They will be looking for noncovered/unnecessary services,incorrect coding,insufficient documentation and duplication of services.

The auditors will be compensated on a contingency basis-the more problems they find the more money they make.This bounty hunting program will be costly to physicians even if they are not audited and even if no problems are found.The time spent preparing for a possible audit will be costly in office staff time and physician time taken away from the actual practice of medicine.

This is happening now and we can look forward to a new program proposed in the Baucus bill for penalties for "outlier physicians" in which the top 10% of "resource user" physicians will be penalized without regard to the patient mix or any other potential explanatory factor. Every year there will be some 10% penalized.

Meanwhile,none of the proposed health care deconstruction-reconstruction bills will do away with the draconian SGR with its built in ratcheting down of physician payments. The specter of ever decreasing Medicare payments, more auditing hassles and the overarching and recurrent uncertainty of what Congress and/or CMS will do next as well as the decreasing satisfaction of the officist practice of internal medicine makes me wonder why anyone would op to do training as a general internist.

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