March 16, 2001
Audit Reform and Provider Education Legislation Introduced
Legislation designed to improve the way the Health Care Financing Administration (HCFA) and its contractors conduct overpayment audits as well as educate physicians and other providers on claims issues has been introduced in both the House and Senate. "The Medicare Education and Regulatory Fairness Act of 2001" (MERFA, S. 452/H.R. 868) was introduced March 5 and 6 and is sponsored by Sen. Frank Murkowski (R-Alaska) and 7 other Senators and Reps. Patrick Toomey (R-Pa.), Shelley Berkley (D-Nev.) and 40 other representatives.
Of specific interest to the AAMC is the proposal's provision that require HCFA to undertake four pilot projects to test documentation guidelines prior to any new guidelines being put into effect. One of the four pilot projects would be conducted in a teaching setting. As HCFA is currently conducting a comprehensive review of the "Evaluation and Management E/M Documentation Guidelines" used by physicians to document billable services to patients, the AAMC would like to ensure that any revisions to the guidelines be considered within the context of HCFA's Teaching Physician regulatory requirements. Such a pilot in a teaching setting would hopefully prevent any new requirements from placing a burden on teaching physicians. S. 452/ H.R. 868 also requires HCFA contractors to educate physicians and providers as to coding, documentation and billing requirements, so that fewer billing errors ultimately occur.
Moreover, MERFA reforms the audit process and provides physicians and providers with due process rights in post-payment audit situations. Specifically, the bill prohibits certain carrier and/or fiscal intermediary activities related to recouping overpayments while enabling with the ability to appeal and challenge regulations and overpayment allegations.
The AAMC and 54 other physician organization support the legislation and are asking Members of Congress to cosponsor the legislation. The introduction of the legislation is particularly timely in light of congressional interest to reform HCFA.
Information: Lynne L. Davis, AAMC Office of Governmental Relations, 202-828-0526.
