Facts about the Medicare Program Problems

The determinetion of a locality
la left to the Secy for defin-
ition and development.

Remedies

Patients should ask dr. to prepare detailed, itemized

Office visits (3 types) and surgical
procedures usually miscoded. Unless
reasons for higher charges are stated bill showing any compli-
by physician, the normal level of re- cations.
imbursement is chosen.

LOCALITIES

Locality designations may be out of
date, having failed to account for
shifting economy and population pat-
terns since their inception.

Medicare's approach is inconsist-
ent. If fees from one segment differ
substantially from rest of locality,
mix willbe affected disproportionately.
In N. J. 8 regions set initially
have been reduced to 3, combining
inner cities with suburbs inspite of
different conditions in each. Result
18 lower reimbursement.

States should be on guard
for such changes. Congres-
sional representatives
could pressure Secy and
carrier to remedy inap-
propriate designation of
locality.

Note: A discussion of some alternatives to the current basis for reimbursement appears in the 1978 Report of on Ways and Means of the House of Representatives. Proposed Amendments to the Medicare Program by the Subcom. on Health of the Com. I am awaiting a copy if this.