Medicare “fraud” that isn’t…

The media is full of Medicare fraud this and Medicare fraud that, but there is little attempt to put anything in context, creating an exceedingly poisonous atmosphere for physicians. I’ve posted before on the kinds of elements taken out of context that can easily be labeled as errors by the checklist mentality.

To further complicate matters, medical billing is extremely complex and few patients, much less media types writing about the subject, understand this complexity. Dr. Richard Patterson, in his post “If I Don’t Like the Outcome, You Must be Cheating,” has done a wonderful job of explaining how medical care gets billed for, and in easily understood terms just how simple it is for the checklist mentality to label something fraud when it isn’t.

The upshot is that Medicare has discovered that the size of claims submitted to Medicare have grown larger with the use of electronic medical records (EMRs).  So Medicare is desperately looking for “fraud” as the cause.  What has happened, as Dr. Patterson so clearly demonstrates, is that physicians, with the aid of EMRs, are able to create more complete notes on the patient care they provide, which legitimately allows physicians to submit higher charges. The result: physicians haven’t substantially changed their care patterns, but rather, physicians are now able to easily document the complexity of the care they provide. With the help of EMRs, physicians are able to substantiate a level of payment they should have been receiving for years.

Kudos to Dr. Patterson!

dhaugen
Some young HR person once looked at my CV and asked me, quite seriously, if I had really done everything I had listed there. Well, yes. Because I am someone who can't sit in a Morris Miller cubicle every day, much less for any great stretch of time. Once the problem is solved, I get bored and I'm ready to move on to the next challenge. This hasn't afforded me any great stability in my work life. I simply arrive in places about ten years ahead of time. So far, at least, that penchant for early arrival hasn't been accompanied with a pocketbook full of door knobs.
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