HHS: Not enough data on Medicare opt-out docs

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Results from an analysis of 7,900 providers who have opted out of Medicare between 1998 and March 2011 by the U.S. Department of Health & Human Services’s (HHS) Office of Inspector General showed that not enough data were available regarding the physicians who opted out of Medicare to conduct a proper evaluation.

The proposed evaluation sought to determine the characteristics of physicians who opt out of Medicare, whether the number of opted-out physicians increased or decreased over time and why they choose to opt out.

“Although the percentage of physicians who choose to opt out may be small, monitoring the number of opted-out physicians and their specialties is important to ensure that Medicare beneficiaries have sufficient access to providers, including specialized providers,” the report noted. “Additionally, having appropriate data on opted-out physicians is essential to ensuring that such physicians are not inappropriately receiving Medicare payments.”

The report, published Jan. 26, did state that, based on the limited data, the number of opted-out physicians appears to have increased each year from 2006 to 2010.

“The quality of the data and lack of procedures for Medicare Administrative Contractors’ (MACs) handling of opted-out physicians impedes the Centers for Medicare & Medicaid Services’ (CMS) oversight of this aspect of the Medicare program,” the report concluded. “Although we acknowledge that CMS guidance addresses the procedures that MACs and legacy carriers must have in place for processing opt-out affidavits, we believe that further direction is necessary to account for data on physicians who filed affidavits between 1998 and 2008.”

The agency stated it will conduct a full evaluation when a complete data source of opted-out physicians is available.