DATA RELEASED ON PHYSICIAN BILLING TO MEDICARE

Approximately $77,000,000,000 was paid out to physicians and other health care professionals in 2012.

The Department of Health and Human Services has released a set of data giving details for 880,000 health care providers.   The data covers the Medicare Part B Fee-For-Service program.

To examine more details, visit the physician dataset here.

There is a detailed write-up on the Mintz Levin blog “Health Law & Policy Matters“.

CHANCES OF SUCCESS IN APPEAL OF DENIED MEDICARE CLAIMS

According to the American Hospital Association in its RACTrac Survey, hospitals have had a reasonable chance of overturning denied claims:

  • Basic appeal rate:  49%
  • Percentage overturned: 64%

In the period October 1, 2009 to September 30, 2011, the RACs tagged 1.1 million claims with overpayments.

  • Number appealed:  6%
  • Success in overturning appealed claims: 44%

Based on data from Office of Inspector General in a 2013 report on RACs: Medicare Recovery Audit Contractors and CMS’s Actions to Address Improper Payments, Referrals of Potential Fraud, and Performance (August 2013, OEI-04-11-00680)