Changing physician behavior: does medical review of Part B Medicare claims make a difference?
This study attempts to determine whether the implementation of mandatory review of Medicare Part B claims for medical necessity has resulted in physicians submitting fewer medically unnecessary claims. After summarizing the literature on the effectiveness of various methods for changing physician practices, we compare the rate at which physicians submitted medically unnecessary claims before and after HCFA imposed mandatory review screens. We find that, consistent with expectations from the literature, the screens are only marginally effective (at best) in reducing the rate at which medically unnecessary claims are submitted. We make some suggestions for lowering this rate.
Nyman
J A
JA
Division of Health Services Research and Policy, University of Minnesota, Minneapolis 55455-0392.
Feldman
R
R
Shapiro
J
J
Grogan
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C
Link
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D003363:Cost Control; D004502:Education, Medical, Continuing; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D007345:Insurance Claim Review; D007348:Insurance, Health; D006278:Medicare / Q000706:statistics & numerical data*; D015442:Medicare Assignment / Q000706:statistics & numerical data*; D010380:Peer Review; D010818:Practice Patterns, Physicians' / Q000191:economics*; D014481:United States