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Congressional Report: Congress Has Some Unfinished Business as New Term Begins AAMC Efforts Help Roll Back CMS Paperwork Requirements Innovations in Medical Education: Doctors-in-Training Learn How to Tell Stories Healing Deep Wounds: Program at Bellevue / NYU Provides Care for Torture Survivors Nursing Shortage Prompts Creative Solutions Author Q&A: 'Sometimes Wrong, Never in Doubt' 'Flagging' Debate Continues; Data Show Score Fluctuations A Word from the President "A Day in the Life of a Medical Student"
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AAMC Efforts Help Roll Back CMS Paperwork RequirementsIn a move prompted in part by AAMC efforts over the past several years, the Centers for Medicare and Medicaid Services (CMS) published revisions Nov. 22 to its Carrier Manual Instructions (CMI) that significantly reduce the documentation burden on teaching physicians providing evaluation and management (E/M) services to Medicare patients.
The changes, which do not alter Medicare's rules for billing by teaching physicians, appear in the "Supervising Physicians in Teaching Settings" section of the CMI. They allow a teaching physician who provides E/M services to refer to a resident's note. This does not change, however, the requirement that the teaching physician must be present - and provide personal documentation - for the "key portion" of his or her participation in the management of the patient. The revised CMI also provides examples of the types of documentation that will be minimally acceptable to CMS. The AAMC applauded the revisions. "A teaching physician's efforts to deliver patient care and train residents should take precedence over elaborate and burdensome documentation requirements," said AAMC President Jordan J. Cohen, M.D. "We are pleased that our efforts over the past several years have succeeded in convincing CMS to reduce the amount of paperwork required of teaching physicians." Paul Rudolf, M.D., J.D., a senior technical advisor at CMS, said that the purpose behind the changes is to clarify any confusion that might have arisen over the past years regarding the scenarios described in the Medicare Carrier Manual. "We felt that the number of inquiries about our [documentation] requirements was mounting, and that clarification of our policies was in order," Dr. Rudolf said. Reducing the burdenThe revisions constitute a positive change for teaching physicians and academic health centers, Dr. Rudolf said. "We hope the changes will reduce the burden on teaching physicians, increase the time they have available to take care of patients, and reduce the time that physicians need to fully comply with our regulations," he said. The revisions should reduce the amount of documentation required for visits and consultations given by physicians or residents under their supervision. Each of these E/M services is assigned a current procedure terminology (CPT) code for billing purposes, which is used for processing claims for the professional services of physicians. Since visit and consul-tation services are high-volume physician activities, the E/M codes are the most frequently used by physicians in daily practice. To bill for a patient visit conducted at a clinic, office, hospital, emergency department, or nursing home setting, a physician must select an E/M code that best represents the service performed. The codes are organized into various categories by delivery site of service, then into as many as five code sub-levels. All categories and code levels are intended to provide physicians with an opportunity to select the code that best reflects the extent of the work done. The more work performed, the higher the level of a code that can be billed within the appropriate category. Removing double efforts"The responses that I've had from colleagues in academic medicine around the country regarding the latest revisions have been positive," said Albert Bothe Jr., M.D., chair-elect of the AAMC's Group on Faculty Practice (GFP) Steering Committee, chair of the GFP subcommittee on legislative and regulatory issues, and executive director of University of Chicago Practice Plan. "This represents a significant simplification of the guidelines and elimination of duplicate work by teaching physicians and reflects the CMS's effort to simplify the regulatory burden on teaching physicians," Dr. Bothe said. Before the latest published changes to the CMI, doctors in academic medical centers were required to write down information that may already have been put in the medical record by the resident. "We have done away with the onerous requirement of having teaching physicians repeat the words of residents, or essentially write down words that don't really add to patient care," Dr. Rudolf said. "But it is still not enough for doctors to write 'I agree,' or 'I review the note and agree.' They must actually document that they were with the resident during the delivery of the service, or that they performed the service themselves." The new CMI replaces requirements that have been in place since 1996. The AAMC has been working with the CMS to improve the provisions in the CMI to more accurately reflect the way in which patient care is provided in academic institutions. The revisions are effective on the date of their publication. n - Suria Santana, ssantana@aamc.org |
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