Report: About 2 percent clinicians are responsible for 25 percent of Medicare Part B payments

Jan 6, 2014 | Health Insurance Billing

The cost of health care in the United States continues to be a concern, but some of this is due to errors by accounts receivable management. Hospitals may be experiencing a larger patient population, but many of these patients rely on assistance from Medicare. By not taking the steps to ensure that these claims are processed appropriately, practices may face hefty repayments to Medicare.

Last month, an audit completed by the Office of the Inspector General (OIG) found that some practices are overbilling Medicare Part B by millions of dollars. In fact, 2 percent of doctors accounted for about 25 percent of all Medicare payments.

"These clinicians were responsible for average annual payments of approximately $1 million," the report explained. "Clinicians generating high Part B payments represent a greater risk to Medicare if they bill incorrectly or commit fraud."

In the past, a collaboration between the U.S. Justice and Health and Human Services departments recovered $4.1 billion in 2011 and $4.2 billion in 2012, which is about a return of eight dollars per dollar spent on these investigations.

This year, more than 300 physicians received $3 million in Medicare payments among 38 hospitals. Out of this pool, about 13 practitioners overbilled Medicare by $34 million, Fierce Health Finance reported. Although the OIG found that many of these errors were from inpatient claims that could've been done as an outpatient procedure.

For example, at the University of Wisconsin Hospital and Clinics, this facility made consistent in and outpatient errors, causing overpayments to reach more than $300,000. On the other hand, St. Elizabeth's Medical Center in Massachusetts will have to repay Medicare $1.2 million for overbilling.

Assistance from Medicare may be available to all practices, but it is up to the hospital's accounts receivable services to ensure that related claims are processed correctly. In situations where they cannot, Professional Medical Services is available to alleviate the backlog.