Policy & Law

Upcoding

1 Mins read

Would Congressman Ryan’s proposal solve this problem?

Would Congressman Ryan’s proposal solve this problem?

Medicare Part B pays outpatient physicians according to the billed Current Procedural Terminology (CPT) codes, which differ in procedure and intensity….Using nationally representative data from the 2001 to 2003 Medicare Current Beneficiary Survey, this paper…finds strong evidence that these fee differentials influence physician’s coding choice for billing purposes across a variety of specialties. For general office visits, Medicare outlays attributable to upcoding may sum to as much as 15% of total expenditures for such visits.

Likely no. For physicians paid by private insurers, they would still have an incentive to upcode. It is possible that private insurers may be better at policing upcoding, but their extra vigilience may also cause physicians to hesitate from providing necessary services since they fear they’ll be targeted for upcoding. On the other hand, for integrated managed care organizations like Kaiser Permanente, they have the opposite incentive. These providers are rewarded for reducing cost and thus insurers may claim to have providers services they did not in fact perform.

Although privatizing Medicare and/or Medicaid could solve some problems, upcoding is not likely to be one of them.

Related posts
Medical EducationPolicy & Law

Why Refinancing Medical School Lending Makes Sense

2 Mins read
Once you graduate from medical school you probably assume your financial situation will improve dramatically. While it is true that you will…
Policy & Law

Here’s What You Need to Know About Post-Accident Action Items

3 Mins read
Comedians and entertainers love to poke fun at lawyers, especially those who specialize in car accidents or other personal injury claims. But…
Medical EthicsPolicy & Law

5 Steps to Starting a Medical Malpractice Suit

2 Mins read
If you have been a victim of medical malpractice, it may seem overwhelming to even contemplate bringing forth a medical malpractice suit….