Dr. Bruce Hensel
4 the First Time: In an investigation into what doctors were billing Medicare for patient office visits, NBC4 discovered that a group of local physicians billed Medicare for the most expensive type of office visits -- 100 percent of the time. Dr. Bruce Hensel and the NBC4 I-Team investigate for the NBC4 News at 6 p.m. on Thursday, May 22, 2014.
How much should a doctor charge for your office visit? The cost depends on the amount of time the doctor spends face to face and the tests and treatments which are done, according to Medicare.
The highest rate typically is supposed to be charged for a visit that lasts at least 40 minutes, and evaluates and treats a moderate to severe problem. These are the longest and most expensive office visits and accounted for less than 5 percent of all Medicare office visits in 2012.
But some doctors are billing Medicare for the most expensive visits 100 percent of the time.
In partnership with ProPublica, NBC4 looked that the billing records of more than 16,000 doctors who saw Medicare patients in 2012, the most recent data available.
About 337 of these physicians -- about 2 percent -- billed Medicare for the most expensive office visits for every Medicare patient they saw.
Medicare consultant Jim Frogue says this pattern raises questions about how these doctors are billing.
"Is it possible they’re legitimate? It’s possible," Frogue said. "It’s possible but it’s unusual and needs more scrutiny."
The doctors NBC4 identified only billed for the highest and most expensive level.
So how do you check your doctor’s billing and background? ProPublica has developed an online tool called called Treatment Tracker that allows consumers to compare their doctors, physical therapists and other health providers to others based on newly released data on the services they provide in Medicare’s Part B program.
Here is what Dr. Bruce suggests you look for and ask about:
The Treatment Tracker tool can also help you identify: