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U.S. Warning to Hospitals on Medicare Bill Abuses

Posted Thursday, October 11th, 2012

To all AAEM Members:

The Academy has been made aware that there is intense scrutiny on EM billing practices. Note the NY Times article published on 9/25/12 by Abelson and Creswell calling attention to the increased billings. A recently completed investigation by the Office of the Inspector General (OIG) has identified emergency physicians as one of the groups that have increased their coding levels dramatically over the last decade.

On page 10 of this report, you will note that ED visits account for the fifth highest number of EM payments by Medicare. The graphic demonstrates that level 5 billing for ED visits has increased 21%. Contrary to what some believe, emergency medicine is a major player in the economics of Medicare physician payments. The report indicates that the OIG has already identified 1,700 physicians who bill EM level 4 and 5 at least 95% of the time. Emergency medicine ranks third — having 10% of the physicians billing in this manner.

The OIG has given this list of 1,700 physicians, which includes 170 emergency physicians, to CMS who has forwarded this to the Medicare Administrative Contractors for investigation. Additionally, CMS will prepare their own report on the 5,000 top physician billers. The bottom line is to be advised that EM physicians are under the microscope. This also highlights the ability of each emergency physician to have access to the books in order to see what is being billed in your name as the Feds do hold the individual physicians accountable.

AAEM Board of Directors