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Physician Groups Divided on GAO Self-Referral Report

Margaret Dick Tocknell, for HealthLeaders Media, July 29, 2013

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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1 comments on "Physician Groups Divided on GAO Self-Referral Report"


erowe (8/6/2013 at 5:39 PM)
The article neglected to mention that if the In Office Exception is eliminated, many more Medicare services will be provided in hospital outpatient departments, which costs much more (sometimes more than 2 times more) than services provided in a physicians' office. The GAO reports also ignored this consideration, so their conclusion that this self referral cost more money than if those physicians had to send the studies out, is invalid. The CAP has a very vested interest in this issue, because they will get all the business that is denied to the treating physicians who are "self referring".