Health Law Gurus

I’ll Be Watching You: Medicare Billing Info on over 880,000 Providers Released by CMS to Improve Transparency

Every payment you take, every claim you make, someone will be watching you. No, we don’t mean Sting. We mean all the consumers and businesses that will have greater access to physician billing information now because today the Centers for Medicare and Medicaid Services (“CMS”) released billing and payment information for over 880,000 practitioners. This is a departure from past practice (backed up by a 1979 court ruling) where such information was kept under wraps, a policy that had been supported by physicians in the past. The goal of the new policy is to make Medicare reimbursement payments more transparent with the ultimate aim of reducing costs, the general idea being that transparency will lead to greater accountability from doctors seeking Medicare reimbursement.

According to a Department of Health and Human Services (“HHS”) news release, the data set, called “Medicare Provider Utilization and Payment Data”, contains “information for over  880,000 distinct health care providers  who collectively received $77 billion in Medicare payments in 2012, under the Medicare Part B Fee-For Service program.” By visiting the CMS website, those interested in the data can download Microsoft Excel spreadsheets covering different segments of the alphabet by provider last names. The data release, which has been anticipated since January when CMS revised its policies, is much broader than expected—previously, CMS had indicated that it would determine whether to release individual physician payment information on a case-by-case basis. Instead, CMS released the data wholesale, without the need for individual review. According to HHS, this data will make it “possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers.”

There have already been reactions to the news from within the medical field. Before the data release, the American Medical Association (“AMA”), for example, raised concerns about the breadth of the data release and advocated for physician review and comment before data is released. The AMA is concerned that this wholesale data release will lead to confusion and misinterpretation of the data, which will ultimately hurt physicians. As reported in a New York Times article, the president of the AMA comments that the release “gives us no window into quality or anything of that nature.”

The New York Times was given access to the data before the release and had a chance to analyze the set.  Among some of its findings is a notable statistic: “About 2 percent of doctors account for about $15 billion in Medicare payments, roughly a quarter of the total ….” Time will tell what effects the data release will have on accountability. CMS Administrator Marilyn Tavenner acknowledged that, “while there is still work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”

We encourage you to share your experiences and thoughts about transparency in physician billing with us and our readers in the comments section below.

To read the HHS news release, click here.

To view Medicare Provider Utilization and Payment Data, click here.

To read the New York Times article, click here.