April 1998 AAOS Report
The Board of Directors, meeting March 18 in New Orleans,
adopted an action plan to seek delay in the implementation of
the Health Care Financing Administration’s (HCFA) Evaluation
and Management (E/M) documentation guidelines and find alternative
solutions that are less onerous and complex than the guidelines
which are scheduled to go into effect July 1. Under the plan,
the Academy will work with HCFA, American Medical Association,
state medical societies and specialty societies to develop alternative
E/M documentation solutions that would be tested in pilot projects
without sanctions against physicians before HCFA fully implements
the E/M documentation guidelines. The board also voted to Òpursue
regulatory and legislative protections for physicians from unnecessary
fraud and abuse penalties and sanctions for inadvertent billing
mistakes. In particular, the Academy will support legislative
changes to eliminate the "know or should have known’
standard" which, according to the fraud and abuse provisions
of the Health Insurance Portability and Accountability Act of
1996, is sufficient to prove fraud.
The AMA, national specialty societies and HCFA are
scheduled to meet in Chicago on April 27 to discuss the E/M documentation
guidelines.