Medicare Claims: Will Everyone Know How Much You're Paid?

Leigh Page


March 20, 2014

In This Article

Your Payments Become Public Knowledge

Physicians are still trying to understand the implications of a recent announcement by the Centers for Medicare & Medicaid Services (CMS) that would allow disclosure of physician-identifiable reimbursement data to the public.

After 33 years of these data being under lock and key, a Pandora's box was opened last May when a federal judge in Florida, Marcia Morales Howard, invalidated a 1979 federal court decision that prohibited their use.[1,2]

The change raises all sorts of questions about how the data might be used. Would physician-rating Websites, investigative reporters, or malpractice attorneys be given access? Could a practice's competitors get hold of it? And would physicians have an opportunity to review and correct the data before they are released?

Judge Howard's decision left it up to CMS to formulate policy, but the agency has been tight-lipped. In an unusually terse notice[3] published in mid-January in the Federal Register, CMS basically said the data would be released on a "case-by-case" basis in response to requests. It added that the program starts in mid-March, but that was pretty much it from the agency as far as policy details were concerned.

A few more details, however, emerged in a blog post by Jonathan Blum, Principal Deputy Administrator of the agency.[4] Blum said that basically, 3 groups -- providers, consumers, and investigative journalists -- could access the data, and CMS would apply several criteria. He added that the agency will "consider the importance of protecting physicians' privacy and ensuring the accuracy of any data released, as well as appropriate protections to limit potential misuse of the information."

Blum added that CMS would also create its own reports on physician performance, presumably posting them on its Physician Compare Website. "CMS will generate and make available aggregate data sets regarding Medicare physician services for public consumption," he wrote. The bill currently in Congress to repeal the sustainable growth rate (SGR) also directs CMS to compile such information and post it on Physician Compare.[5]


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