Insurers Pocketing Millions From Medicare By Combing Through Medical Charts For Additional Diagnosis Codes
The practice of identifying the additional codes to send to CMS for payment is legal but costing Medicare millions. Meanwhile, new Medicare cards are being issued, and The New York Times lays out some tips on what you need to know about them.
Modern Healthcare:
Insurers Profit From Medicare Advantage's Incentive To Add Coding That Boosts Reimbursement
Health insurers have perfected a way to wring billions more in revenue from the Medicare program by combing patient medical charts for additional diagnosis codes to submit to the federal government for payment. The latest example of the massive returns that insurers reap from the practice known as a retrospective chart review was outlined in legal documents filed in a case against Indianapolis-based health insurer Anthem. The documents show Anthem pocketed more than $112 million in additional Medicare Advantage risk-adjustment payments in 2015 and $102 million in 2014 while spending little over $18 million each year to carry out the review program. (Livingston, 9/1)
The New York Times:
New Medicare Cards Are Being Issued. Here’s What You Need To Know.
As people across the country receive new, safer Medicare cards in the mail, advocates are warning about fraudulent callers who try to dupe people into paying money or divulging personal information. The government is gradually replacing Medicare cards for the 60 million people covered by the federal health plan. Previously, the cards used the recipient’s Social Security number as his or her Medicare number, which posed a risk of identity theft. Congress mandated a change in 2015. (Carrns, 8/31)
