Health Affairs Blog: The Integrity Of MACRA May Be Undermined By “Incident To Billing” Coding
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January 8, 2018 - The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 ended the Sustainable Growth Rate formula that for years had resulted in an eleventh-hour intervention by Congress to avoid drastic reductions in Medicare physician payments. MACRA also established incentives for clinician payments to become increasingly based on value with the intent of rewarding clinicians who produce better outcomes at lower costs. Efforts are underway to establish the outcomes and quality measures that will be included in the new payment systems.
Yet, paying for value assumes that billing data used by Medicare correctly identify the physician’s services. In this post, we argue that because other health professionals can bill under a physician’s national provider number (NPI)—a practice known as “incident to billing”—the link between what physicians are doing and how they appear to Medicare based on their claims data is tenuous indeed. Until the practice of incident to billing is properly coded in claims data, the goals of MACRA will be undermined.
“The Integrity Of MACRA May Be Undermined By “Incident To Billing” Coding, " Health Affairs Blog, January 8, 2018.DOI: 10.1377/hblog20180103.135358
Authors: Peter Buerhaus, Jonathan Skinner, Benjamin McMichael, David Auerbach, Jennifer Perloff, Douglas Staiger, Lucy Skinner