August 3, 2001

House Committee Proposes Administrative Changes for CMS

In a July 31 letter to HHS Secretary Tommy Thompson, the House Committee on Energy and Commerce identified several administrative reforms that the Centers for Medicare and Medicaid Services (CMS) should initiate as it begins efforts to reduce Medicare's complexities and burdens. The Committee's recommendations were shaped by a series of hearings and surveys regarding provider and beneficiary concerns.

The Committee advised the agency to release provider and contractor information on a regular schedule, ease the level of regulatory paperwork, and work with providers to improve Medicare's coding systems. Additionally, the letter encouraged CMS to clarify repayment options for returning Medicare overpayments. Providers had asked specifically that the Energy and Commerce Committee consider three-year payment plans or offsets for overpayments exceeding $5,000.

The Committee also identified broader reforms, including implementing agency-wide, long-range strategic planning, clearly defining contractor duties and responsibilities, and placing Medicare experts in local Social Security offices to answer beneficiary and provider questions. The letter criticized both CMS and Medicare contractors for providing inconsistent, unclear, and excessive guidance to physicians and hospitals, and advised the entities to reformat bulletins and other educational materials. It also suggested that CMS and its contractors organize notices of regulatory changes according to medical and surgical specialties.

The letter advised CMS to streamline existing paperwork requirements to afford providers more time with patients and less time with Medicare forms. Specific suggestions included clarifying Certificates of Medical Necessity (CMNs), working with physicians to reassess and restructure Evaluation and Management (E&M) documentation, and modifying/expediting the provider enrollment process. The letter also encouraged CMS to reconsider current documentation requirements for physicians who supervise medical residents.

Focusing part of the letter on the unique needs of emergency departments, the Energy and Commerce Committee requested that CMS review and resolve conflicts between Advanced Beneficiary Notices (ABNs) and EMTALA requirements. It specifically suggested that CMS consider modifying the ABN policy within emergency departments to allow completion of ABNs immediately after EMTALA requirements are met. The Committee also asked CMS to consider allowing the enrollment and direct payment of emergency department medical groups, regardless of whether services were provided by employees or independent contractors.

Information: Christiane Mitchell, AAMC Office of Governmental Relations, 202-828-0526.