“Thousands of doctors and other medical professionals have steadily billed higher rates for treating elderly patients on Medicare over the last decade — adding $11 billion or more to their fees and signaling a possible rise in medical billing abuse.”
That’s a statement from a study of Medicare billing and coding practices released by the Center for Public Integrity, and is the lead on a lengthy and well-documented article detailing the dramatic increase in higher-complexity medical codes billed to Medicare over the last decade.
The implications for taxpayers, private insurers, workers comp and auto payers are obvious. If docs and their billing departments are upcoding for Medicare office visits, they almost certainly are doing the same for all patients.
Interestingly, the increasing use of electronic medical record systems by many physician practices may be a contributing factor, as the systems “make it easy to create detailed patient files with just a few mouse clicks.” These details are essential to demonstrating and documenting the level of work and time commitment involved in specific office visits.
That said, just because a doc has mostly higher-level office visits doesn’t mean they are doing anything wrong. Some providers’ patients are just sicker (“higher acuity”) than others’, requiring more time and effort.
What does this mean for you?
It is highly likely your mix of E&M codes has trended towards the more complex over time. You may well want to identify those docs where the mix has swung dramatically at some point as that may indicate inappropriate billing.