TMA uncovers


Medicare mistakes


W 24 TEXAS MEDICINE July 2015


hen physicians talk about leaving the Medicare program because of its many broken parts, it’s not just talk, and the Texas Medical Association recently uncovered some major Medicare gaffes that show just what pushes doctors to the brink.


TMA did not let Medicare pull the wool over physicians’ eyes with


under-the-radar audits of the Physician Quality Reporting System (PQRS). A staff investigation revealed that veiled threats of recoup- ments were causing unnecessary angst for physicians because the unexpected reviews are not even mandatory at this stage. Medicare also apparently had trouble with its own complex payment formu- las, but the questionable calculations did not slip by TMA. Payment detectives uncovered technical errors in an early draft of the 2015 Physician Fee Schedule that had trickled into payment notices. They incorrectly led nonparticipating (non-PAR) physicians to believe they were overbilling their patients, potentially costing doctors those pa- tients and their livelihoods.


BY AMY LYNN SORREL PHOTO BY BRETT BUCHANAN


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