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January 27, 2012 at 09:02 AM
Officials at the Office of Inspector General for the U.S. Department of Health and Human Services (HHS) say the Centers for Medicare & Medicaid Services (CMS) has no good way to track how many physicians are opting out of Medicare, let alone why departing physicians opt out.
Stuart Wright, a deputy inspector general, writes about problems with counting Medicare providers in a memorandum on physician decisions to opt out of Medicare that was sent earlier this week to Marilyn Tavenner, the acting CMS administrator.
Many physicians and physician groups have argued that uncertainty about Medicare physician reimbursement rates is chasing physicians away from the program and has the potential to limit Medicare enrollees’ access to physicians in some parts of the country.
The HHS inspector general’s office started to look into the matter in April 2011, to find out which physicians were opting out and why, but investigators discovered there was no way to get good data on opted-out providers, Wright says.
One challenge, Wright says, is that physician decisions to opt out expire after 2 years, and the 16 Medicare administrators and claims payment contractors are not doing a good job of keep track of whether opt-out decisions have expired, or whether some physicians have resumed participating in Medicare.
