Does Publishing the Parameters that Trigger Review of Medicare Claims Change Provider Behavior

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

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• Statistical Methods for Rates and Proportions

  Open Access•Joseph L Fleiss, Bruce Levin et al.•Statistical methods for rates and…•2003

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• The Impact of Changing Medicare Reimbursement Rates on Physician-Induced Demand

  Thomas Rice, Thomas H Rice•Medical Care•1983

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