A HHS study found physicians are still improperly billing Medicare enrollees for services of which they should be exempt, according to The New York Times.
Here are five things to know:
1. Despite official warnings about fines or being excluded from Medicare, the study found improper billing is "relatively commonplace" as some Medicare providers "unlawfully" bill Medicare enrollees after the providers obtained payments from Medicare and Medicaid.
2. HHS said many patients are not aware of the billing restriction or are worried they will lose their physicians so they pay the amounts. Other times, collection agencies deal with obtaining the unpaid bills or patients forgo care due to inability to pay.
3. The Obama administration filed a report citing their concerns to the Federal Register nearly two weeks ago, as well as submitted a notice to providers in February and a letter to payers in April.
4. However, some states have policies limiting how much they will reimburse physicians. The New York Times provides an example where a physician performs a procedure for a Medicare patient for $100. Medicare pays $80 so the physician bills the patient $20. However, if the patient is also on Medicaid and Medicaid charges $70 for the service, some states will not pay the remaining balance as the state considers it to be paid in full. Many states save money billing for Medicaid rates, as opposed to Medicare rates.
5. The administration has told physicians if they participate in Medicare, they must adhere to the balance-billing prohibitions even if they also accept Medicaid patients. However, many physicians claim they aren't always aware if a patient qualifies for Medicare and is thus exempt from Medicare's cost-sharing recruitments. Due to this lack of awareness, the government is bolstering efforts to educate both patients and physicians about Medicare's requirements.
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