Feds propose shakeup for emergency room billing

By Fred Schulte

Proposal seeks to counter alleged over-billing with standardized rate

Excerpts from this story referencing "American Medical Association":

"… so-called Evaluation and Management codes being used were designed by the American Medical Association for physician billing, not emergency room services. Doctors pick one of th …"

Feds 'listen' for sounds of Medicare billing abuse

By Fred Schulte

Baltimore session looks at role of electronic health records in higher medical bills.

Feds tighten scrutiny of health records

By Fred Schulte

Feds increase scrutiny of how electronic systems affect billing

Excerpts from this story referencing "Medicare fraud":

"… ruary 2009.  …"

Suit alleges retaliation for exposure of upcoding

By Fred Schulte

Nevada woman claims she was fired after questioning hospital's bills

Excerpts from this story referencing "Florida":

"… The company’s billing arm, for instance, states on its website that one Florida hospital increased its facility charges by 47 percent using the firm’s s …"

IMPACT: Cabinet officials signal crackdown on Medicare billing abuse

By Fred Schulte and Joe Eaton

Sebelius, Holder signal new scrutiny in wake of Center series

Excerpts from this story referencing "Medicare":

"… stepping up scrutiny  for doctors and hospitals that may be cheating Medicare by using electronic health records to improperly bill the health plan for …"

"… al professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees.The Cent …"

"… overed a broad range of costly billing errors and abuses that have plagued Medicare for years—from confusion over how to pick proper payment codes to outrig …"

"… proper payment codes to outright overcharges. The findings indicated that Medicare billing problems are worsening as doctors and hospitals switch to electron …"

Billing complexity spawns new industry

By Fred Schulte

Thousands now employed as professional coders, but oversight is lacking.

Excerpts from this story referencing "Florida":

"… go away so long as doctors are paid by the number of services they provide.Florida consultant Frank Cohen, for instance, believes that little will change unl …"

Hospitals grab at least $1 billion in extra fees for emergency room visits

By Joe Eaton and David Donald

Center probe suggests facilities have taken advantage of government’s failure to set billing standards.

Excerpts from this story referencing "American Medical Association":

"… s using a set of codes developed and licensed for physician billing by the American Medical Association — so-called Current Procedural Terminology, or CPT, codes. The lack of s …"

"… is reticent to sign off on an outside group’s system, as it has with the American Medical Association, which licenses the use of the CPT codes it owns and administers. In writ …"

"… t form 2008. Unlike hospital billing, CMS requires that physicians follow American Medical Association criteria for billing emergency room evaluation and management services. Th …"

Growth of electronic medical records eases path to inflated bills

By Fred Schulte

Billing software helps medical professionals document higher fees.

Excerpts from this story referencing "Florida":

"… e state of Washington in 2006 alleged that Health Management Associates, a Florida-based hospital chain, used software called Pro-Med Clinical Systems that p …"

How doctors and hospitals have collected billions in questionable Medicare fees

By Fred Schulte and David Donald

Center investigation suggests cost from upcoding and other abuses likely tops $11 billion.

Excerpts from this story referencing "Medicare":

"… sionals have steadily billed higher rates for treating elderly patients on Medicare over the last decade — adding $11 billion or more to their fees and sign …"

"… treatments that take more time and effort. But the Center’s analysis of Medicare claims from 2001 through 2010 shows that over time, thousands of providers …"

"… 2010 shows that over time, thousands of providers turned to more expensive Medicare billing codes, while spurning use of cheaper ones. They did so despite lit …"

"… ile spurning use of cheaper ones. They did so despite little evidence that Medicare patients as a whole are older or sicker than in past years, or that the am …"