A prosecutorial coding climate will add to the burden of generalism and make it even less attractive. The irony is that a visit with a generalist is the biggest bargain CMS will ever get, no matter what level it is coded. The more generalists per region, the lower the costs, and the higher the quality.

A dermatologist gets 90% of his income from discrete procedures, as does an orthopedic surgeon. They can downcode their E/M services, writing them off as loss leaders, and thus minimizie their vulnerability to an attack-dog type audit recrimination. A general internist gets 90% of her income from small piecemeal E/M services, can’t survive by undercoding, and will be weighted down by the fear of misinterpretation for every service of every day. Not a good climate for professional satisfaction. Not ideal working conditions to foster patient-centered care.

Criminal? Really? I think HealthSouth and Tenet’s constant fraud problems would be a better example?

Speaking of criminal or “selective ignorance” what about this tidbit – from a Congressional Quarterly 2-29-08 article – Examples of improper payments CMS cited include a health care provider who bills Medicare for conducting three colonoscopies on the same patient on the same day; payments that are coded for one Medicare service when in fact another was performed; or a health care provider who is paid twice because they submitted duplicate claims.

Also, would like to point out Capps’ ignorance to her own issue/bill -on Feb. 28 – Congresswoman Capps was quoted as saying, “inpatient rehabilitation facilities make up 88 percent of the claims denied in the Medicare Recovery Audit Program.” To paraphrase – this is the whole basis for my continued fight against this program.

WRONG!

Per the CMS FY 2007 report (page 18, Table 2-6), inpatient rehab facilities represent $20.8 million of the $357 million recovered or 5.8%, not 88% as Capps claims.

What it did say is that 88 percent of the overpayments recovered in ‘07 came from inpatient rehab facilities. Leading one only to believe they are better bilkers than other healthcare providers. Smooth move, Capps.

Also, the Feinstein story is dead. It’s time to move past Whitney’s hospital lobbyist sound bites and join all of us in 2008.

Furthermore, since you brought up on my favorite stories of ‘07 – I love this quote – “These rules have been on the books since 1985,” Combs said. “Maybe it’s possible some have been overlooking them. Maybe there have been CONSULTANTS out there helping hospitals to, quote, MAXIMIZE REIMBURSEMENTS. And maybe perhaps some of that has entailed looking the other way.” YA THINK?