A scathing investigative report from the Center for Public Integrity repeats OIG’s E/M utilization trend findings from this past May, while also refuting physician claims that patients got sicker and older in the past decade.
But, as reported in Part B News, the Center finds that CMS is not likely to target possible E/M upcoding in a widespread review.
The Center report, also featured in the Washington Post, is based on a one-year analysis of roughly 362 million Medicare claims. Among the key findings:
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E/M levels 4 or 5 were selected on about 40% of doctor visit claims in 2010, compared to 25% in 2001.
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Both the average patient age and the reasons they presented for the visits remain virtually unchanged from 2001 to 2010.
The May 2012 OIG report, “Coding Trends of Medicare Evaluation & Management Services,” promised a follow-up study assessing whether fraud, abuse or improper billing contribute to increased level 4 and 5 utilization. While we wait for that, here’s hoping OIG can detail how much blame rests on electronic health record cloned notes (PBN 6/4/12, DH Daily 9/11/12), a belief widely held by industry experts.