tci Medicare Compliance & Reimbursement - 2007 Issue 15
INDUSTRY NOTES: Medicare Already Has Toolkit For Finding Wasteful Doctors
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Article Overview
This industry note reviews Medicare’s potential use of claims data to identify outlier physician utilization, summarizes CMS quality reporting preparation, and highlights a few additional Medicare and HHS developments. It is relevant for physicians, coders, compliance staff, and practice administrators who follow Medicare reporting, modifier use, and broader payment-policy news.
Why This Topic Matters
It helps readers understand current Medicare oversight and reporting topics that can affect how claims are prepared, how quality measures are reported, and how practices interpret payment policy changes and enforcement activity.
Article Sections
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Medicare claims data and physician profiling
Discusses Medicare’s existing data resources and the idea of using them to examine physician service patterns and regional comparisons.
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CMS unveils quality reporting specs
Summarizes CMS quality reporting preparation, including how specifications tie measures to claim information and the use of reporting-related modifiers.
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In other news
Covers additional Medicare and HHS developments, including a rural payment complaint and a fraud-related court decision.
What You Will Learn
- How Medicare data resources relate to physician oversight topics
- What CMS quality reporting specifications are addressing at a high level
- Which general reporting categories and modifiers are discussed in connection with quality measures
- What other Medicare and HHS policy and enforcement items are mentioned
Who Should Read This
- Physicians
- Medical coders
- Compliance staff
- Practice administrators
- Revenue cycle professionals
Modifiers Discussed
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