RTI International and U.S. Department of Health and Human Services, Answering the Medical Expenditure Panel Survey

By Jeanne A. Gilreath, OHCC, CHBME, Senior Vice President & Chief Compliance Officer

Question:  What is my obligation to provide information to RTI, who calls our office stating that (s)he is “calling on behalf of the U.S. Department of Health and Human Services (HHS) for Medical Expenditure Panel Survey (MEPS)?” It seems that the representatives from RTI are very assertive and when we respond that we will not participate in the survey request, the representative requests to speak with a supervisor.

Answer:  No legal or regulatory requirement compels a billing company to provide information to RTI International, formerly known as Research Triangle Institute, a nonprofit organization headquartered in Research Triangle Park near Raleigh, North Carolina.  RTI provides research and technical services in eight practice areas.   In short, RTI is a survey company contracted by U.S. government agencies to administer certain annual surveys in the eight practice areas described below.

• Health Care Transformation
• Behavioral Health
• Health Behavior Change
• Precision Medicine
• Public Health and Well-Being
• RTI Health Solutions (RTI-HS)

In the Health practice area, a subcategory of focus is Health Care Transformation, which RTI describes as “analyzing and evaluating health policy issues, from access to payment, with a focus on underserved populations.” A key ingredient in this research is payment and that’s where we come in, as the billing company (revenue cycle management) for our physician clients. One of RTI’s objectives is to collect high-quality data from businesses, agencies, schools and other [healthcare] organizations.

“MEPS is the only national data source measuring how Americans use and pay for medical care, health insurance, and out-of-pocket spending.  Annual surveys of individuals and families, as well as their health care providers, provide data on health status, the use of medical services, charges, insurance coverage, and satisfaction with care.”[1]

There is one component to this national survey, the Medical Provider Component (MEPS-MPC), which impacts AdvantEdge’s staff through the countless survey calls made to the Company by RTI. According to the Agency for Healthcare Research and Quality (AHRQ) which is part of U.S. Department of Health & Human Services; MEPS is the most complete source of data on the cost and use of healthcare and health insurance coverage in the U.S. MEPS-MPC is administered by RTI International and Social & Scientific Systems, Inc. (SSS).

Understanding the Survey Design

“The MEPS-MPC collects data from hospitals, office-based doctors, home health agencies, institutions (such as long-term care facilities) and pharmacies reported by MEPS Household Component (MEPS-HC) respondents as well as doctors who provide services for patients in hospitals but bill separately from the hospital (Separately Billing Doctors).

“Each cycle, providers for the MPC sample each year are identified in three rounds of HC data collection. The panel design of the survey, which features five core rounds of interviewing, covers two full calendar years. The MEPS-HC collects data from a sample of families and individuals in selected communities across the United States, drawn from a nationally representative subsample of households that participated in the prior year’s National Health Interview Survey (conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention).

“During the household interviews, the MEPS-HC collects detailed information for each person in the household including demographic characteristics, health conditions, health status, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment.

“The basic sample unit in the MPC is a patient-provider pair where the patient is a member of a household participating in the HC and the provider is identified in the household survey as one associated with a medical event, that is, an office visit, a hospital stay, a prescription for medicine, or other health care event. Respondents in the HC are asked to identify all medical providers associated with health care services received by each member of the household. Household members are asked to sign an Authorization Form (AF) indicating their agreement to allow providers to release information about the event to the MPC. This form is compliant with the Health Insurance Portability and Accountability Act (HIPAA) implemented in 2003.

“Eligibility for the MPC is restricted to services rendered in a hospital or by a medical doctor or doctor of osteopathy (MD or DO) or under the supervision of an MD or DO. Services provided by dentists, optometrists, psychologists, podiatrists, chiropractors, and other kinds of health care practitioners who do not provide care under the supervision of an MD or DO are excluded from the MPC. Care provided by home care agencies is an exception to this criterion; the sample design includes all care provided through a home care agency.”[2]

When AdvantEdge is contacted by RTI; it is to collect information regarding the provider component (MEPS-MPC) with information obtained from providers of medical care that supplements the information collected from persons in the MEPS Household Component (HC) sample to provide the most accurate cost data possible. The reason billing companies are receiving these calls from RTI is that they have engaged patients in providing healthcare services information to RTI, and RTI follows the information flow eventually landing at the billing company.

AdvantEdge employees have complained that RTI’s survey techniques are edgy in that the caller is not candid about who they represent or the requirement to provide the information. The caller typically does not identify themselves as an RTI employee/contractor. Instead, the person says that (s)he is calling on behalf of a government agency, e.g. Department of Health & Human Services and that the caller is contacting AdvantEdge on behalf of the patient to obtain billing and payment information.    Many individuals, including patients, don’t hear “on behalf of” and think they are speaking with HHS, and patients, as well as some employees, may feel intimidated by this or in the case of patients may feel that there is a benefit to them, by providing information to HHS, including lowering their healthcare costs or improved access to providers. Once you agree to provide the information to RTI it is not a one-and-done event. “MEPS is a continuing data collection effort designed to track changes in health status, use of healthcare services, costs of healthcare and access to healthcare. Each year a new sample of households is selected to provide data for the study for two full calendar years. And each year the MEPS Medical Provider Component contacts the pharmacies/hospitals/medical providers reported by the household participants.  A provider may be contacted in successive years if a household reports receiving care in consecutive years or if households in a new sample report seeing the same providers as households in a previous sample”[3]

“The legislation authorizing this study specifies that the data be collected for research purposes. It is designed to provide government policymakers and private researchers with accurate information about the rapidly changing health care situation in this country and to inform decisions made about health care policy.”[4]

“The confidentiality of data collected for MEPS is protected by Federal law under Sections 924(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 242m(d)]. Identifying information collected for the study cannot be released without the permission of the individuals or establishments who provided the information.”[5]

The landline number that is used is 919-926-6511 which is owned by RTI International and operated by Level 3 Communications, LLC.

Although the surveys administered by RTI on behalf of HHS are legitimate and necessary projects; we are not required to participate. The demands made of time and attention are too great for many billing companies to participate in MEPS data gathering activities. Imagine, you are a billing company with 5,000 providers, and through sampling, RTI requests information on 10% of the company’s client providers with 5 patients for each provider (we have had requests for up to 25 patients for a single provider)  – 500 providers x 5 patients each provider = 2,500 targeted individuals (patients) with potentially multiple dates of service. We now know that it is a continuing data collection effort over multiple years, and each year the provider may be contacted in successive years if households in a new sample are seeing the same providers.

In the 2010 Medical Provider Component Contact Guide for Separately Billing Doctors, it states, “Public reporting burden for this collection of information is estimated to average 5 minutes per response, the estimated time required to complete the survey.”   Doing simple math on the 2,500 targeted individuals previously mentioned equates to hundreds of hours of lost time where productive work is disrupted.

Although the work of RTI on behalf of the Agency for Healthcare Research and Quality (AHRQ) of HHS is important to understanding healthcare trends that affect consumers of healthcare services; until the model changes regarding third party time commitments; it is not likely that billing companies will be able to support the process due to the demands of a rapidly changing business environment related to the work billing companies do for their clients.

Ms. Gilreath has more than thirty years’ experience in the healthcare industry. At AdvantEdge, she is the Chief Compliance Officer, reflecting ongoing industry changes and policy throughout AdvantEdge. She is also responsible for client development and expansion of value-added services to clients.

AdvantEdge Healthcare Solutions is a national top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical groups since 1967.   If you have questions about how AdvantEdge can improve your billing and coding to collect every dollar that you’re legally and ethically entitled, please call us at 877-501-1611 or email info@ahsrcmstg.wpengine.com.

[1] https://www.ahrq.gov/data/meps.html (accessed Nov. 7, 2019).

[2] https://meps.ahrq.gov/data_files/publications/annual_contractor_report/mpc_ann_cntrct_methrpt.shtml#preparations (accessed Nov. 8, 2019).

[3] https://meps.ahrq.gov/communication/participants/faq_gen_mcp.shtml#FAQ02, FAQ #11 (accessed Nov. 7, 2019).

[4] Ibid, FAQ #7 (accessed Nov. 7, 2019)

[5] Ibid, FAQ #8 (accessed Nov. 7, 2019)