Questionable Medicare billing practices draw scrutiny

Jun 12, 2014 | Health Insurance Billing

It can sometimes be difficult to distinguish between providers who might make an honest billing mistake from those who are attempting to take advantage of the system. However, The Wall Street Journal's investigation into some provider's reimbursement practices are clearly a cause for concern. 

Medicare physician data payment information was made available to the public for the first time in April. The mountains of data take advanced analytics or an enormous investment in man-hours to decipher, and new areas of concern are being continuously brought to the public's attention. 

The Wall Street Journal recently found that more than 2,300 providers earned $500,000 or more from Medicare in 2012 from a single procedure or service. Some of these providers collected far and above more than their peers, as was the case with Dr. Ronald Weaver. 

Dr. Weaver is not a specialist in cardiology, but the Journal found that he received 98 percent of his $2.3 million Medicare payout from performing a single cardiac procedure. 

According to the source, the procedure is rarely used even by cardiologists, who used it on less than 5 percent of their patients on average. Dr. Weaver administered it to 99.5 percent of his Medicare patients, billing the program 615 times. For context, the Cleveland Clinic, famous for its cardiology services, used the procedure on only six patients last year.

Abuse of the Medicare program can greatly affect a care center who relies on reimbursement ability to provide quality patient care. If your practice is looking to run a more efficient and effective accounts receivable department, Professional Medical Services can help you clear up these outstanding accounts with the utmost efficiency by using a combination of automated tools and knowledgeable staff.