How complex are health regulations?: The 140,000-code question

DOCTORS complain that honest errors in how they code treatments are often mistaken for skulduggery, and that the automation of claims-monitoring could make this worse. It is, they say, becoming harder to stay on the right side of the rules as billing requirements grow more convoluted. Medicare will next year have 140,000 different codes, including nine for injuries caused by turkeys. (Was the victim struck or pecked? Once or more often? Did she suffer negative after-effects? And so on.)Many clinics have fallen under suspicion and had payments suspended, only to win a reprieve when the facts are examined closely. Medicare alone has a backlog of nearly half a million appeals.Carousel Pediatrics, a children’s clinic, was at first accused of fraud and told to repay $18m, plus $4m in penalties. But when investigators took a closer look, it was asked to pay just $3.75m for unintended errors. John Holcomb of the Texas Medical Association suspects the case is likely to make doctors in the Austin area reluctant to take Medicaid patients. Already, 80% don’t.

from The Economist: United States http://ift.tt/1k7Ki0L