Changes being sought to simplify Medicare
Efforts would cut the bureaucracy
Besides pushing for changes in the proposed physician compliance guidelines, provider organizations are lobbying Congress and the Health Care Financing Administration (HCFA) to simplify current Medicare regulatory and administrative procedures.
Among the changes being sought:
• Form 855. Redesigning and simplifying the Form 855 used to enroll and re-enroll physicians in the Medicare program is a major priority. A recent draft of the revised form was still 48 pages long. Private sector enrollment forms, meanwhile, average five to eight pages. Providers are also upset because when a form is not filled out correctly, physicians must resubmit their applications. The form then goes to the back of the line and often takes another eight to 12 weeks to process again.
• Advance beneficiary notices. Under current law, if a physician wants to bill a Medicare beneficiary for a service not covered by Medicare, the physician must request that the beneficiary sign an Advance Beneficiary Notice (ABN). The ABN states that the service may not be covered and that the beneficiary must pay for the service in full if Medicare does not cover it.
Many provider organizations say that creates a barrier in the physician-patient relationship, fostering an environment of mistrust.
• The Health Insurance Portability and Accountability Act (HIPAA). Providers say they appreciate HIPAA’s goal of simplifying and standardizing electronic data interchange formats. They also recognize the need for upgrading security and privacy matters relating to practice software and hardware systems, plus any required training. But in turn, physicians want HCFA to provide some kind of training or financial assistance to help offset those costs. Additionally, medical organizations want to be relieved of potential liability for a breaches of security or patient privacy by a provider’s electronic trading partner.
• Post-payment audit/review. HCFA contractors subject practices to post-payment audits intended to identify possible billing errors from a relatively small sample of claims, then use those possible errors to extrapolate any projected overpayments. Often, however, there is an error in those random samples, which means the estimated overpayment is incorrect.
Under current HCFA policy, the only practical alternative practices have for challenging the auditors’ initial finding — and still retaining their appeal rights — is to ask the agency to perform what’s known as a statistically valid random sample. However, since that can be highly disruptive, many practices simply decide to repay the alleged overpayment. Practice groups want to change that situation, plus give providers more options when it comes to retaining their right to appeal HCFA decisions.
• Notification. The process by which HCFA and Medicare carriers announce policy changes is too random, and physicians want a more standardized and formal process. For instance, policy information could be sent to Medicare providers free of charge. Now, providers now must pay to obtain the correct coding initiative edits.
• HCFA reorganization. Provider organizations want to consolidate the various managed care functions that reside in three different parts of the Center for Health Plans and Providers into a single unit under a single director. That, some say, would speed communications, make it easier to obtain policy interpretations, and streamline the management of Medicare intermediaries.
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