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ACP-ASIM Calls Medicare Reform Act (H.R. 2768) Good First Step, Urges A Number of Improvements

September 25, 2001

(Washington, DC): The "Medicare Regulatory and Contracting Reform Act of 2001," H.R. 2768, is a good start toward reducing unnecessary paperwork, but more should be done, according to testimony presented today to the House Ways and Means Subcommittee on Health by American College of Physicians - American Society of Internal Medicine President William J. Hall, MD, FACP.

"Time is the most valuable resource in diagnosing and caring for older adults, but it is in short supply due to unnecessary paperwork," said Dr. Hall. "Medicare patients suffer when physicians and their office staff are diverted from patient care activities to paperwork."

ACP-ASIM supports the bill's provision that precludes carriers from requiring physicians and other health care providers to repay an "alleged" overpayment until after the first level of appeal. ACP-ASIM believes that repayment should not occur until the administrative appeals have been exhausted.

Dr. Hall suggested a series of improvements to HR 2768.

  • Eliminate the extrapolation of alleged overpayment amounts to other non-audited claims the first time a physician or other health care provider is assessed an alleged overpayment, unless fraud is suspected. A "high level of payment error" should be defined. ACP-ASIM also recommends that carriers should conduct a documented education effort before a provider receives an overpayment demand letter.
  • Establish three year payment plans for high-volume Medicare providers.
  • Afford physicians the ability to appeal a sample of claims without requiring a "statistically valid random sample" (SVRS).
  • Mandate that Medicare carriers not demand additional records or documentation prior to paying a claim absent cause except when developing contractor-wide or program-wide claims payment error rates.

"ACP-ASIM strongly supports the bill's provision that requires the Department of Health and Human Services initiate three or four pilot projects to test E/M documentation guidelines, "said Dr. Hall. "ACP-ASIM is particularly interested in the peer-review pilot method and the use of encounter time to reduce burdensome documentation."

Dr. Hall expressed support for provisions that require Medicare contractors to: (1) respond in a clear, concise and accurate manner to specific billing and coding and cost report questions; (2) maintain a toll-free telephone number which provides information regarding billing, coding and other appropriate information; (3) maintain a system for identifying who provides referred information; and (4) monitor accuracy, consistency and timeliness of the information provided.

ACP-ASIM suggests that these provisions be further strengthened by requiring a binding written response within 30 days from the contractor to physicians and other providers who submit billing, documentation, coding and cost reporting questions to carriers or fiscal intermediaries.

"ACP-ASIM believes that it is time for Congress to introduce more due process rights and fairness into the Medicare claims payment review system so that the overwhelming majority of physicians and other health care providers, who are honest and law abiding, no longer have to suffer from onerous and unfair Medicare rules," said Dr. Hall.

American College of Physicians-American Society of Internal Medicine (ACP-ASIM) represents more than 115,000 physicians and medical students. It is the largest medical specialty society and the second largest medical organization in the United States.

[Note to Editors: Copies of the ACP-ASIM's testimony can be obtained at http://www.acponline.org/hpp/menu/medref.htm ]

Jack Pope, ACP-ASIM Washington Office, 202-261-4556
Jennifer Whalen, ACP-ASIM Washington Office, 202-261-4575

Page updated: 11-03-03

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