So much for the idea that the providers will have much lower costs if they deal with a government payer -
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How Medicare Paperwork Abuses Doctors and Harms Patients
heritage.org
Edit - A couple of quotes from that article
"...Beyond its financial problem, the Medicare program has many more problems. These are rooted in a little-understood aspect of the program--the huge regulatory morass that governs Medicare. The prestigious Mayo Foundation has estimated that the number of pages of federal regulations and related paperwork that doctors and hospitals must comply with in order to treat Medicare and Medicaid patients totals more than 132,000 pages--almost 111,000 of which govern Medicare alone. This is roughly six times the size of the impossibly complex Internal Revenue Service code and its federal tax regulations..."
"...When physicians bill Medicare, they are mindful of the fact that the Medicare insurance carrier will scrutinize every billing entry, questioning its medical necessity and reasonableness. They are also mindful of the fact that the Medicare fee schedule places caps on billing amounts for services and is uniformly below market rates. In addition, they know that the costs of complying with Medicare record-keeping requirements often equal or exceed the fee amounts Medicare pays.
Consequently, if Medicare subjects a physician to any inquiry, investigation, or audit, those acts carry with them costs--taxes, in effect--that can cause service to Medicare beneficiaries to result in a net loss for the practice. Many physicians now experience that net loss and must depend upon higher-than-market rates for services to patients not in Medicare to compensate for the losses.
The Medicare carriers, the entities contracting with HCFA, employ sophisticated computer programs that flag billing "outliers" and trigger automatic inquiries upon repeat occurrence of atypical billing patterns. Those inquiries can lead to Medicare inquiries, audits of a physician's patient files, and investigations by federal and state authorities, including the United States Attorney's office, the HHS Office of Inspector General, the Federal Bureau of Investigation, and local law enforcement. Indeed, Medicare inquiries, audits, and investigations are frequently the prelude to either a reimbursement demand or legal action for Medicare fraud or abuse.
Obtaining legal counsel to explain the physician's rights, Medicare procedures, and defenses can cost tens of thousands of dollars. Indeed, a single erroneous bill for less than $100 not infrequently ends up causing the physician to spend tens of thousands, if not hundreds of thousands, of dollars to pay legal fees and to satisfy ultimate reimbursement demands made by Medicare..."
"...The American people are largely unaware of the extraordinary costs the federal government has imposed on the practice of medicine. No solo or small group practice in the United States can comprehend the full extent of their legal obligations under Medicare without consulting with lawyers, and few can fulfill their legal obligations properly without consulting with accountants and risk managers. There are literally thousands of rules covering every aspect of a physician's practice, from renting office space to giving and receiving referrals to determining whether each particular service is covered under Medicare or is covered only if "bundled," attendant to a Medicare "covered" service, or necessary for emergency care.
To minimize risks--elimination of risks is not possible, because the law is forever changing--requires personnel on staff trained in billing, coding, risk management, and compliance; counsel from lawyers expert in the field; counsel from accountants; and counsel from risk managers. Those costs are borne by the physician and must be paid for, ultimately, by the patients. Because Medicare law prohibits billing Medicare patients for covered services beyond a fee-limited amount, the costs are invariably borne by the patients not enrolled in Medicare.
Every time the Medicare bureaucracy conducts an inquiry, investigation, or audit, and every time it sends a reimbursement demand, a doctor must pay for legal and accounting advice. The risks of being wrongly accused are so high that no doctor can protect his or her own best interests without the aid of a plethora of professionals. The costs are taxing solo and small group medical practices to death..." |
