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Part B Insider (Multispecialty) Coding Alert

PHYSICIAN NOTES:

Patients Regained Lost Ground In Medicare Physician Access Struggle

Published on Thu Jan 20, 2005

But patients may be getting used to long waits for treatment

Medicare patients lost the ability to reach physicians at an alarming rate between 1997 and 2001 - but then their access stabilized in 2002 and 2003, according to a new survey by the Center for Studying Health System Change.

The proportion of Medicare beneficiaries who reported they had to delay care or couldn't find care when they needed it was 9.9 percent in 2003, roughly the same as 1999's level of 9.8 percent and down sharply from 2001's 11 percent. But one-fifth of seniors said they faced long waits for appointments in 2003, up from 14 percent in 1999.

Patients may have gotten used to longer waits for appointments, and this may explain why fewer patients believe they've "delayed" receiving care, notes the study ("An Update On Medicare Beneficiary Access To Physician Services ," Issue Brief No. 93).

The Center warns that policymakers risk reducing access to Medicare once again if steep cuts to physician payments take effect from 2006 to 2013.

The Center's report comes on the heels of a similar report from the Government Accountability Office that stated Medicare beneficiaries had improved physician access from April 2000 to April 2002. The percentage of beneficiaries receiving physician services rose from 42 percent in April 2000 to 46 percent in April 2002, said the GAO report ("Medicare Fee-for-Service Beneficiary Access to Physician Services: Trends in Utilization of Services, 2000 to 2002," GAO-05-145R).

The proportion of Medicare services performed by participating physicians increased, and this meant physicians were less likely to be able to "balance bill" patients for a charge in excess of the Medicare allowable plus copayment, the GAO notes.

In Other News:
 

  • The number of claims denied due to incorrect patient name or Health Insurance Claim number has tripled since Medicare changed its policy to require an exact match for beneficiary first initial, last name and HIC number, the Centers for Medicare and Medicaid Services warned. CMS issued a special Medlearn Matters article to help providers avoid these problems, at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0516.pdf.

  • The HHS Office of Inspector General issued another scathing report on "place of service" errors. In "Review of Place of Service Coding for Physician Services" (A-02-04-01010), the OIG estimates that carrier Empire Medicare Services may need to recoup as much as $1.5 million in overpayments from physicians. Eighty-eight of 100 sampled physician services paid by the carrier used the "office" POS code, even though they were facility services.

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