Nine Medicare Data Limitations Reporting by the CMS

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The Centers for Medicare and Medicaid Services (CMS) recently published the 2012 Medicare payment information for 880,000 physicians. Many physician advocacy groups, such as the American Medical Association (AMA) and the American College of Physicians (ACP), are concerned with how this data has been managed. These physician groups are claiming that the release didn’t include the necessary information to help the public interpret the information. Releasing information without context can be misleading; it can produce inaccuracies, misinterpretations, and false conclusions. With the information in its current state, both payers and patients are unable to draw any significant conclusions about the quality of their healthcare.

The AMA has outlined nine limitations of the data. In doing so, they hope to encourage the media to consider these faults when reporting on the information released by CMS. These limitations include:

  1. Errors: Physicians weren’t provided with an opportunity to review and edit the information before it was published.
  2. Quality: Quality measurements were not included in the data, so it’s not possible to accurately evaluate the quality of care.
  3. Number of services: Midlevel providers may bill under the same National Provider Identifier number, so it’s not exactly clear who has performed the services.
  4. Charges vs payment: Medicare and other payers pay fixed prices for services based on fee schedules. For that reason, the amount paid to physicians is often far less than what was charged. It’s not an accurate representation of payment.
  5. Patient population: The data lacks information on private insurance patients and Medicaid patients.
  6. Site of service: Where the service was provided can affect the payment amount.
  7. Provider comparisons: The vague specialty descriptions and practice types may make provider comparisons confusing or misleading.
  8. Missing information: Patient demographics haven’t been included in the data.
  9. Coding and billing changes: Billing rules may vary between different regions of the country.

These rule changes need to be taken into account. The AMA says they plan on continuing their work with the CMS in order to develop an efficient process for reporting errors in Medicare payment data.

Author: Lauren Daniels

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