tci Medicare Compliance & Reimbursement - 2005 Issue 3
Physicians: Has The Sustainable Growth Rate Outlived Its Usefulness?
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Article Overview
This piece summarizes a Government Accountability Office report on how CMS updates the practice expense component of the Medicare physician fee schedule. It is aimed at readers who follow Medicare payment policy, physician reimbursement, and data collection practices used in fee schedule updates. The article focuses on concerns about the timeliness, representativeness, and transparency of the underlying update process.
Why This Topic Matters
The article matters because the way CMS maintains physician practice expense data affects the integrity of Medicare payment updates and the confidence providers have in the fee schedule process.
What You Will Learn
- How CMS uses physician survey data and expert panel input to update practice expense estimates.
- What concerns the GAO raised about the timeliness and reliability of the update process.
- Why the transparency of CMS’ methodology is relevant to Medicare payment policy.
- What the report says about the need for a more systematic data collection approach.
Who Should Read This
- Physician coders
- Medical practice managers
- Medicare reimbursement specialists
- Health policy analysts
- Compliance staff
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