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Facts about the Medicare Program Problems

oeding year.
But annual increase
in prevailing charge is limited

to a fixed percentage cap, an
economic index, reflecting
changes in expenses of practice
and changes in general earnings
levels.

Source of data is controlled
by HCPA and the carrier.

It is the Secretary who de-
cides "similar services,"
"locality," & appropriate
"economic index."

Remedies

A proper mix of all charge s
by doctors would result in more
equitable reasonable charge &
higher reimbursement.

Federal guidelines require
that in determining reason-
able charge, consideration
must be given to doctors'
charges to general public and
not only to Medicare patients.
But carriers have generally
limited data source to Medi-
care claims, and doctors don't
want to disclose their charges.
Difficulty in mixing data from

different coding terminology plus
unwillingness of doctors & in-

surers to divulge the data, have
resulted in a confined data pool..

(Study shows Drs. charged non

Medicare patients more than they

charged Medicare patients.)

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Data Gathering. Statute provides

that prevailing charge is to be determined on July 1st through use of charge data from previous calendar year.

Data is outdated by the time it's used. It varies in age from 1/2 to 1 years on July 1st, and by its end on the following June 30th, data is up to 2 years old.

This is a single nationwide index as determined by Secy.

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lative history for single nation- Congress could presaure DHHS wide index. In fact, legisl. history shows that Congress wanted use of several economic indexes.

into setting inflationary cap at a level commensurate

with actual health care cost inflation rate.

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charge "as their charge to patients. by dodgers should be elimin

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