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
Global HealthcarePolicy & Law

Do HMOs Deserve A Bad Reputation? The Truth Of Managed Healthcare

3 Mins read
Have you ever heard people say that HMO health insurance is no good? It’s no secret that HMOs have a bad reputation,…
Policy & Law

Top 4 Important Things To Understand About Insurance

2 Mins read
When it comes to Medicare, the enrollment process can be a little tricky. That’s why it’s important to understand the relevant health…
Health carePolicy & Law

Elmiron Controversy Highlights Need For Longterm Clinical Drug Testing

4 Mins read
Elmiron has recently been the subject of a number of lawsuits brought about over claims that the drug causes vision problems and may lead…