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ACP-ASIM lends support to 'MERFA' legislation to reduce Medicare paperwork

Wednesday, March 7, 2001

Washington, DC—The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) fully supports the "Medicare Education and Regulatory Fairness Act" (MERFA) being introduced by senators Frank Murkowski (R-Alaska) and John Kerry (D-Mass.) and representatives Pat Toomey (R-Pa.) and Shelley Berkley (D-Nev.).

Medicare's complex regulations have created a heavy paperwork burden that significantly reduces the time doctors spend with patients, according to William Hall, MD, FACP, president-elect of ACP-ASIM and a practicing geriatrician.

"As internists, we provide quality care to more Medicare patients than any other physician specialty," Dr. Hall said. "Medical research breakthroughs, new pharmaceutical products and improved diagnostic equipment are of limited value if doctors lack the time to spend with patients to determine what is best for them."

Under Medicare regulations, physicians must comply with numerous federal rules and local contractor policies to complete claim forms, provide advance beneficiary notices, certify medical necessity, file enrollment forms and comply with code documentation guidelines. Yet, there is no single source that physicians can access to learn Medicare's rules and policies.

A preliminary finding that a physician did not follow Medicare's complex rules can result in an extraordinarily time-consuming series of subsequent events. Medicare may deny the claim and/or demand more paperwork documentation. It may institute an audit of the physician's Medicare claims, causing a virtual shutdown of a physician's practice. It may deny payments for similar claims based on a statistical sampling of claims submitted, without even looking at the actual records for those other claims. If the physician appeals a denial, this launches yet another complex process with its own set of time-consuming rules and paperwork requirements.

"In the world of clinical practice, efficient use of physician time is essential," Dr. Hall said. "Time is the most valuable resource in caring for the patient and it exists in the shortest supply due to unnecessary paperwork."

MERFA would address this problem by better targeting current Medicare education dollars to provide needed outreach and education to physicians and by instituting common-sense reforms:

  • Medicare rules and policies and answers to frequently asked questions would be made more accessible, and physicians would be given advance notice about changes in rules.
  • Medicare would be required to pay its claims, without demanding more paperwork, unless there is evidence that the bill is incorrect.
  • Medicare would be required to actually look at the records, rather than making an assumption that some claims were billed incorrectly based on a statistical sample.
  • Medicare's ability to investigate fraudulent claims would be preserved, while overpayments would be reduced by educating physicians on how to prevent inadvertent billing mistakes.

"The Medicare Education and Regulatory Fairness Act is a common-sense effort to reduce needless paperwork so that I can spend more time taking care of my elderly patients, rather than taking care of the bureaucracy," Dr. Hall said.

David Edelson, ACP-ASIM Washington Office, 202-261-4575
Jack Pope, ACP-ASIM Washington Office, 202-261-4556

Letters to Congress supporting Medicare Education and Regulatory Fairness Act

Page updated: 11-04-03

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