The Fermi problem: Estimation of potential Billing losses due to Undercoding of Florida Medicare data

Abstract

Billing issues are more commonplace than most healthcare professionals, including pharmacists, even realize. Undercoding—or billing outpatient visits for a lower level of service than may be justified—leads to decreased reimbursement, but almost no data captures what is being sacrificed, especially at the state level. Using publicly available data from the National Ambulatory Medical Care Survey and Centers for Medicare and Medicaid Services, we attempt to approximate just how much Medicare reimbursement is lost annually to undercoding in Florida. We also discuss the hidden dangers of undercoding, including how it could hinder the ability of clinical pharmacists to build sustainable clinical services and contribute to the broader healthcare team.

Keywords

• Pharmacy billing
• Medicare
• Incident-to
• Undercoding
• Clinical pharmacists