MIL-OSI USA: Ciscomani, Davis Lead Bipartisan Push for Increased Transparency in Medicare

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Source: United States House of Representatives – Congressman Juan Ciscomani (Arizona)

WASHINGTON – U.S. Representatives Juan Ciscomani (AZ-06) and Don Davis (NC-01) led a bipartisan push this week to increase transparency within the Centers for Medicare and Medicaid (CMS), specifically concerning the program’s billing codes. The legislation, titled the Oversight of Medicare Billing Code Cost Act, directs the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) to conduct a study of the processes used by CMS to add, change, or remove Medicare billing codes. It is co-sponsored by Representatives Diana Harshbarger (TN-01) and Bill Huizenga (MI-04). Full text of this bill is available here.

With the introduction of the Oversight of Medicare Billing Code Cost Act, Congressman Ciscomani has now introduced 20 bills in the first 14 months he has been in office.

“We must do everything in our power to protect Medicare and Medicaid for our seniors,” said Rep. Ciscomani. “To do so, we must understand what is driving up costs, which is exactly what the report proposed by this bill would do. When we can identify and mitigate those issues, we increase its solvency and keep the program available to our seniors for years to come.” 

“Medicare beneficiaries are entitled to full transparency about their billing,” said Rep. Davis. “For the public good, we must support a comprehensive study of Medicare billing codes. Our seniors deserve as much information as possible when making health care decisions for themselves and their families.” 

“We cannot let unchecked actions by federal bureaucrats put seniors and Medicare patients at risk,” said Rep. Harshbarger.“Despite its looming insolvency, CMS has continued to inflate Medicare services without any Congressional oversight, causing costs to spiral out of control. The Oversight of Medicare Billing Code Cost Act is common-sense legislation that will rein in soaring Medicare spending levels and shine a much-needed light on Medicare billing processes, all while protecting Medicare patients and their benefits.” 

“Seniors in Southwest Michigan and across the nation rely on Medicare,” said Rep. Huizenga. “In order to better protect Medicare for today’s seniors as well as future seniors, we need greater transparency surrounding billing and coding practices.  The Oversight of Medicare Billing Code Cost Act will help provide critical insight into how the Centers for Medicare and Medicaid determines which services and treatments are covered and which are not.” 

The bill is also supported by Chris Pope, a Senior Fellow at the Manhattan Institute, and Americans for Prosperity.

“From 2027, Medicare is projected to cost more every year than all federal domestic discretionary spending,” said Chris Pope, Senior Fellow at the Manhattan Institute. “The largest reason for this escalating cost is the addition of new services and procedures to the program. But these expenditures are currently not transparently quantified and recorded. Rep. Ciscomani’s bill is the first serious attempt to shine a light on this dark corner of the federal budget – giving Congress some of the most important information it needs to protect taxpayers.”

“We support Congressman Ciscomani’s proposed the Oversight of Medicare Billing Code Cost Act because it would give Congress better information to make sound decisions about the kinds of treatments and therapies Medicare covers,” said Dean Clancy, Senior Health Policy Fellow at Americans for Prosperity. “The majority of past and projected Medicare spending growth is due to the Medicare agency’s decisions to cover new technologies, some of which are so expensive, they threaten the program’s fiscal sustainability. By promoting informed cost-benefit analysis instead of harmful government price controls, this sensible bill points the way to a better future for seniors and taxpayers alike.”

BACKGROUND: 

  • The OIG report will cover what types of data and analysis CMS considers, what trends exist in their billing code methodology, and what outcomes and specialties they believe will have the highest growth potential. 
  • Based on this, the OIG will make recommendations on what administrative action should be taken, and what possible legislation Congress could consider.
  • From 1997 to 2011, 85 percent of the increase in Medicare spending was on newly created procedure codes.
  • Understanding how CMS decides what new services to cover as well as what factors it considers when deciding to add, change, or remove covered services will allow Congress to keep Medicare costs at a sustainable level without cutting benefits.

MIL OSI USA News