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Medicare Reimbursements Under the Microscope

price transparencyMedicare provider reimbursements have always been a big secret to the general public, but a USA Today article reports that a recent court decision has lifted a 35-year-old gag order, finally releasing some of this information.

Recently released data by the Center for Medicare Services (CMS) came despite an injunction sought by the American Medical Association now lifted after more than three decades of non-transparency.

Unprecedented Transparency

Newly released information shines a light on details as to how much each Medicare provider was reimbursed by Medicare in 2012 and also lists the services provided and the amount reimbursed for those services.

Medicare reimbursements can vary drastically between facilities and demographic areas, leaving most Medicare beneficiaries in the dark when it comes to being aware of what their health care services cost. Most people only find out the actual cost once they receive their quarterly Medicare statement. With more information available about specific doctors, laboratories and hospitals, consumers can make pre-emptive choices about their own medical care.

Fraudulent billing won’t be so easy in the future, either. For example, it was reported that some ophthalmologists were able to bill for millions of dollars for the treatment of common conditions such as macular degeneration.

Change Comes Not Without Debate

While lifting the veil on reimbursement histories of physicians and medical service facilities is a much needed advance for detecting fraud and over-billing, there is no lack of debate and resistance in the medical community.

The most common (and weak) argument is that consumers just aren’t savvy enough to understand the information released about pricing. Many in the medical profession argue that these seemingly over-billed services are a result of multi-tiered care involving a team of care providers on a single case.

Nevertheless, consumer advocates argue that it is the right of every taxpayer to know where their tax dollars are spent. I couldn’t agree more.

By demanding greater price transparency, you can compare medical pricing between providers and facilities and have more choice in how and where you choose to spend your health care dollars, potentially saving thousands in the long run.

Although this new information only paints a broad picture of Medicare reimbursements, it’s a first step in the right direction in not only helping you become engaged in your health care spending but also in providing a basis for monitoring Medicare fraud.

What do you think?

Wiley Long

Wiley Long

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.
Wiley Long

 

 
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