Dueling New Medicare Reports

Medicare Trustees versus Medicare Actuaries

By Staff Reporters

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According to John Goodman, President, CEO & Kellye Wright Fellow National Center for Policy Analysis, the release of this year’s Medicare Trustees report was unprecedented.

No Medicare Signature Sign-Off 

As noted on www.TheHealthCareBlog.com, in previous posts there and at this blog here and here, Medicare’s chief actuary not only refused to sign off on it, he disowned it — encouraging readers to ignore it and focus instead on an alternative report, prepared by the office of the Medicare actuaries.


Industry Indignation Index: 50


Are doctors different than the average investor noted in this essay?

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5 Responses

  1. Medicare Overpaid $13.8 for Wrong Place of Service Codes

    Medicare contractors overpaid physicians an estimated $13.8 million for claims with the incorrect place-of-service code during calendar year 2007, the HHS Office of Inspector General (OIG) says in an audit report (A-01-09-00503) posted Aug. 13. Medicare reimburses physicians more for certain services they perform in offices, urgent care centers or independent clinics, but pays the overhead to facilities when physicians work in hospital outpatient departments or ambulatory surgical centers (ASCs), OIG explains. Out of 100 sampled services, OIG found that physicians incorrectly coded the claims for 90 services by using non-facility place-of-service codes for services that were actually performed in hospital outpatient departments or ASCs. The coding errors in the samples resulted in overpayments of $4,710, and OIG estimates that contractors nationwide overpaid physicians $13.8 million.

    OIG says CMS should (1) recover the $4,710; (2) reopen the claims associated with non-sampled services and work with physicians to recover any overpayments; (3) continue efforts to strengthen the education process and tell physicians and their billing agents the importance of correctly coding the place of service; and (4) work with program safeguard contractors and coordinate data matches with other Medicare contractors. CMS agreed with the findings and recommendations.

    Source: Report on Medicare Compliance [8/23/10]


  2. Is Medicare A Good Deal?

    Johnn Goodman, from the National Center for Policy Analysis [NCPA], asks us to consider if Medicare is [still] a good deal now or for future generations.

    For example, think about everything we will pay to support Medicare: the payroll taxes while working, the premiums during retirement, and our share of the income taxes that subsidize the system.

    Then crunch the numbers and compare that to the benefits of Medicare insurance, say, from age 65 until the day you die. What do you think?


    Dr. David Edward Marcinko MBA


  3. Fed-up doctors are fleeing Medicare

    More physicians are opting out of the government program for seniors, just as baby boomers are becoming eligible.


    Yet, another report.

    Dr. Joe


  4. Medicare Payments: Breakdown of Top Fifteen Medical Specialties Ranked by Average Paid to Individual Billers

    Provider Type Number of Providers Total Paid in Millions Avg Amount Paid Per Provider

    Hematology/Oncology 7,374 $2,703.9 $366,677.0
    Radiation Oncology 4,135 $1,499.6 $362,566.0
    Ophthamology 17,067 $5,585.0 $327,239.0
    Medical Oncology 2,613 $806.6 $308,702.0
    Portable X-Ray 7 $2.0 $288,020.0
    Rheumatology 4,053 $1,044.5 $257,701.0
    Nephrology 7,503 $1,685.6 $224,657.0
    Cardiology 22,241 $4,965.3 $223,248.0
    Dermatology 10,507 $2,235.3 $212,745.0
    Interventional Pain Mgmt 1,856 $366.1 $197,229.0
    Peripheral Vascular Disease 74 $14.3 $193,441.0
    Hematology 687 $127.6 $185,757.0
    Cardiac Electrophysiology 1,117 $204.0 $182,641.0
    Vascular Surgery 2,696 $485.3 $180,019.0
    Urology 8,791 $1,385.4 $157,589.0

    Data Source: Centers for Medicare & Medicaid Services
    Publication Source: Medicare Spending Tied to Sliver of Providers, April 9, 2014, The Wall Street Journal


  5. Trustees’ Report Says Medicare Will be Insolvent by 2029

    The Medicare trust fund will be insolvent by 2029, the program’s trustees reported.The prediction is a year later than the 2028 date the Obama administration outlined in last year’s report. The Congressional Budget Office in January 2016 estimated the program would be solvent only until 2026.

    Based on the new findings, the feared Independent Payment Advisory Board, which was created by the Affordable Care Act to reign in Medicare costs if they grew faster than a set rate, will not be activated.

    Also of note, 2029 is 12 years longer than projected estimates before the Affordable Care Act become law.

    Source: Virgil Dickson, Modern Healthcare [7/13/17]


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