CMS Data Helps Analyze Hospitalist Billing Outliers
Medicare physician payment data shows that more than 1,000 primary care physicians providing hospital-based services billed Medicare more than five times the average, raising questions about their billing practices.
Medicare physician payment data shows that more than 1,000 primary care physicians providing hospital-based services billed Medicare more than five times the average, raising questions about their billing practices, according to a new analysis from Phoenix-based Innovative Solutions Consulting.
The data reveals that the top 1,000 primary care physicians providing hospital-based services averaged more than 9,300 work relative value units (wRVUs) or 7.5 timesthe average for all primary care physicians and 5.3 times the average hospitalist. The top 263 physicians each billed more than 10,000 wRVUs, with one hospitalist topping out at more than 40,000 wRVUs.
Innovative Solutions Consulting president Abhay Padgaonkar said one explanation for the outlying billers' data is that services rendered by one or several of their associates is billed under a single National Provider Identifier (NPI) number.
Among the factors Padgaonkar cites in influencing high billings are loosely interpreting Q6 modifiers for locum tenens physicians' services; billing for services performed by non-physician providers under the heading of those services being supervised by the billing physician; and billing in a teaching setting.
"The detailed data analysis points to the presence of questionable billing practices among high-earning hospitalists because the single-NPI explanation fails to justify hospital-based workload that would be several times more than the average," said Padgaonkar. "To avoid any unwanted attention and to steer clear of expensive and time-consuming audits, all hospitalists should reexamine their current billing practices for billing under another providers NPI."
The data reveals that the top 1,000 primary care physicians providing hospital-based services averaged more than 9,300 work relative value units (wRVUs) or 7.5 timesthe average for all primary care physicians and 5.3 times the average hospitalist. The top 263 physicians each billed more than 10,000 wRVUs, with one hospitalist topping out at more than 40,000 wRVUs.
Innovative Solutions Consulting president Abhay Padgaonkar said one explanation for the outlying billers' data is that services rendered by one or several of their associates is billed under a single National Provider Identifier (NPI) number.
Among the factors Padgaonkar cites in influencing high billings are loosely interpreting Q6 modifiers for locum tenens physicians' services; billing for services performed by non-physician providers under the heading of those services being supervised by the billing physician; and billing in a teaching setting.
"The detailed data analysis points to the presence of questionable billing practices among high-earning hospitalists because the single-NPI explanation fails to justify hospital-based workload that would be several times more than the average," said Padgaonkar. "To avoid any unwanted attention and to steer clear of expensive and time-consuming audits, all hospitalists should reexamine their current billing practices for billing under another providers NPI."
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