The Effectiveness of Medicare Part B Medical Review: Issues and Alternatives

The part B medical review methods currently used by Medicare carriers to control resource use suffer from a series of problems including failure to reward deter rence of unnecessary claims, failure to detect substitu tion of nonreviewed claims, reliance on average rather than marginal measures of performance, excessive fo cusing of reviews, and the inability to measure effective ness separately from the intervention. This article de scribes these problems and proposes a series of alternative strategies for review that may improve these problems.