Medicare upcoding could be adding to health care costs

Medicare upcoding could be adding to health care costs

The Center for Public Integrity reports on a trend in which many physicians and other medical professionals are billing Medicare for complicated and costly care. Some say this pattern signals an increase in medical billing abuse while others maintain it reflects seniors’ need for more complex care.

The Center for Public Integrity/Washington Post: Doctors, Others Billing Medicare At Higher Rates

Thousands of doctors and other medical professionals have billed Medicare for increasingly complicated and costly treatments over the past decade, adding $11 billion or more to their fees -; and signaling a possible rise in medical billing abuse, according to an investigation by the Center for Public Integrity. … Similarly, hospitals sharply stepped up the use of the highest codes for emergency room visits while cutting back on the lowest codes. Medical groups say the shift to higher codes reflects the fact that seniors have gotten older and sicker, requiring more complex care (Schulte, Eaton and Donald, 9/15).

Meanwhile, in other Medicare news -

Kaiser Health News: Capsules: Hospital Readmission Rates Dropping Slightly, New Study Finds

A new government analysis has found that hospital readmission rates of Medicare patients have fallen more than previously reported, bolstering hope that hospitals are having some success at tackling this stubborn and expensive problem (Rau, 9/14).

http://www.kaiserhealthnews.orgThis article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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