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Physicians: Have You Checked Your Numbers? Re: Medicare Payments to Physicians

As promised, the Centers for Medicare and Medicaid Services released information about Medicare payment to physicians and certain health care professionals on April 9th. The release is in conjunction with the policy change instituted by the U.S. Department of Health and Human Services, which allows CMS to respond on a case-by-case basis to Freedom of Information Act requests for Medicare payment information related to individual physicians (see more on the topic here).

The released data specifically includes information about more than 880,000 health care providers who received payments in 2012 under the Medicare Part B fee-for-service program. The data set contains information on the following:

  • The name and addresses of providers;

  • Number of services;

  • Summaries of services provided; and

  • Amount that providers were paid for the services under Medicare.

Unlike many CMS announcements, the Medicare payment announcement made national headlines – and was quickly followed by considerable scrutiny from physicians and health care associations. The American Medical Association (“AMA”) had this to say about the release: “We believe that the broad data dump today by CMS has significant short-comings regarding the accuracy and value of the medical services rendered by physicians. Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.” The group had requested, to no avail, that physicians be able to check and verify the information before public release.

Now that the information is available, physicians should not only check it for accuracy, but should also be prepared to address patients’ inquiries about Medicare reimbursement and why the report is misleading. Physicians across the United States are arguing that the information paints an inaccurate, and career-damaging, picture. The report does nothing to explain, for instance, that numerous physicians in a practice may bill only under one physician’s name or reimbursement may go directly towards expensive drugs for the patients – not their own pockets. The AMA released a helpful guide (intended for the media) about the concerns that the Medicare claims data presents; physicians can review the points here.

Scrutiny of physicians’ once-personal information is only going to intensify. Under the Physician Payments Sunshine Act, transfers of value given by certain pharmaceutical and device manufacturers to physicians will be posted on a public website via the Open Payments Program after September 30, 2014. In the wake of increasing transparency, physicians must be prepared to explain and defend payments received.

© 2022 by McBrayer, McGinnis, Leslie & Kirkland, PLLC. All rights reserved.National Law Review, Volume IV, Number 114
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About this Author

Christopher J. Shaughnessy, Health Care Attorney, McBrayer Law Firm
Associate

Christopher J. Shaughnessy is an attorney at McBrayer, McGinnis, Leslie & Kirkland, PLLC. Mr. Shaughnessy concentrates his practice area in health care and is located in the firm's Lexington office. He has extensive experience in the health care law industry. Mr. Shaughnessy represents institutions such as hospitals and nursing homes as well as individual medical professionals, including physicians, mid-level practitioners and nurses. He also represents small offices and large offices that are part of large networks. Some of the services he commonly provides are in the following...

859-554-4414
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