Does publishing the parameters that trigger review of Medicare claims change provider behavior? Results of the parameter release study.
In April 1989, the Health Care Financing Administration stopped publishing the parameters that trigger review of Medicare claims because they thought that knowledge of the parameters would permit providers to schedule visits to avoid review. In this article, the authors report the results of an experimental study where previously unrevealed parameters were revealed to some providers of Medicare services and not to others. The authors find little evidence to suggest that providers schedule procedures to avoid review when they know the parameters. There is some evidence, however, that providers may be responding to the release of the parameters in other ways.
D014487:Centers for Medicare and Medicaid Services, U.S.; D005251:Fees, Medical; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare / Q000592:standards* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D011643:Publishing; D012044:Regression Analysis; D014481:United States; D014600:Utilization Review / Q000379:methods*