The APA pointed out that of the four CPT codes at issue, only group psychotherapy was among the top 10 codes billed by psychiatrists to Medicare; it was ranked seventh. The sample of group psychotherapy claims was less than 0.0001% of all claims for the service. The APA argued that the fourth service covered in the report, psychological testing, is rarely claimed by physician psychiatrists. However, it is the number one code billed by clinical psychologists. "We are deeply troubled by a report whose sweeping conclusions are based on an extremely limited sampling of data subjected to a review standard that is in essence the creation of the IG," the APA stated in a letter to Inspector General Janet Rehnquist dated Aug. 15, 2001. The report was formally released in November 2001.
The OIG suggested that the Medicare program "target problematic mental health services for pre-payment edits or post-payment medical review." However, these are exactly the kinds of Medicare audits that have drawn congressional ire.
On Dec. 4, 2001, the House passed the Medicare Regulatory and Contracting Reform Act by a vote of 408 to 0. Physicians would be protected under the bill from sanctions or repayment if, in good faith, they followed written guidance that later was shown to be erroneous. The measure also would establish limits on prepayment reviews that are not purely random, such as those based on voluntary disclosure by doctors. Recovery of overpayments would be prohibited until the contractor level of appeal was completed. The legislation would prevent the use of extrapolation -- when a small sample is used to determine overpayments for a larger number of claims -- unless a sustained or high level of payment error was identified or documented intervention failed to correct the problem.
The Senate version of the bill, which has not been acted on, is less comprehensive than the House bill.