Physician Groups Divided on GAO Self-Referral Report
Instead of a change to the law, the GAO recommends these steps for the Centers for Medicare & Medicaid Services:
- Insert a self-referral flag on Medicare Part B claim forms and require providers to indicate if the claim is for self-referral services.
- Develop and implement a process to ensure the appropriateness of biopsy procedures performed by self-referring providers.
- Develop and implement a payment approach to limit the financial incentives associated with self referral.
Kapoor says it is notable that despite the GAO's contention that self-referring is a cost driver, "it didn't recommend that the law be changed."
The GAO report, the second in a series, was prepared at the request of the Senate Finance Committee, which is leading a bipartisan effort to identify the effects of physician self-referral on the Medicare budget.
The first GAO report, released in October 2012, focused on self-referral for magnetic resonance imaging and computed tomography services. In that report, the GAO estimated that Medicare spent approximately $109 million more in 2010 than it would have without self-referrals. Future reports, expected this year, will cover self-referral in radiation therapy service and physical therapy services.
While Sen. Max Baucus (D-MT), the committee chair, has expressed concern about the report findings, he has not yet endorsed a legislative remedy.
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