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ACP-ASIM Supports New Efforts to Push Forward Medicare Reform

(Washington, DC): The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) applauds the effort behind the "Medicare Appeals, Regulatory and Contracting Improvements Act of 2001,"S.1738, introduced yesterday by Senators Kerry, Murkowski, Baucus and Grassley, announced ACP-ASIM President William J. Hall, MD, FACP.

"This legislation would address many of the regulatory burdens on the country's physicians, and introduce greater due process rights and fairness into the Medicare claims payment review system," said Dr. Hall, "However, we recommend several improvements be made so the bill can provide a fuller range of needed relief."

ACP-ASIM specifically praised provisions in S. 1738 that would:

  • Require Medicare carriers to issue written, correct and consistent responses to questions from physicians within 45 days of the date of receipt. Providers that reasonably rely on the written responses will not be subject to any new penalty or interest if the guidance or response from the carrier was in error. Carriers would also be required to establish toll-free telephone numbers for inquiries, and a system for identifying employees who provide information.

  • Prohibit the Centers for Medicare and Medicaid Services (CMS) from recovering overpayments from physicians and other Medicare providers until there has been an opportunity for reconsideration at the Qualified Independent Contractor (QIC) level of appeal.

  • Allow the Secretary of HHS to develop standards for providers to establish a repayment plan for at least one year, but no longer than 3 years.

The ACP-ASIM encourages improvements that go beyond the scope of the legislation, including:

  • Elimination of extrapolation of alleged overpayment amounts to claims that have not been audited the first time a physician or other health care provider is assessed an alleged overpayment, unless fraud is suspected.

  • Requiring CMS to conduct pilot tests of evaluation and management (E&M) documentation guidelines including one recommended by ACP-ASIM that would be based on patient encounter time. Instituting a time-based E&M pilot test supports a proposal to use patient encounter time as a simpler alternative to other documentation guidelines.

  • Inclusion of language from H.R. 3046 that requires the establishment of an Emergency Medical Treatment and Active Labor Act (EMTALA) task force, peer review organization review prior to provider terminations, and notification of physicians and providers when an EMTALA investigation has been closed.

  • Requiring Medicare Qualified Independent Contractors (QIC) reviewers to be physicians to the extent they are reviewing items and services provided to patients by physicians.

The ACP-ASIM represents more than 115,00 physicians and medical students. It is the largest medical specialty society and the second largest medical organization in the United States.


Jack Pope, Washington Office, (202) 261-4556
Jennifer Whalen, Washington Office, (202) 261-4575

Page updated: 11-04-03

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