May 1998 AAOS Report
HCFA issues delay on E/M guidelines
The Health Care Financing Administration (HCFA) has
delayed indefinitely implementation of the Evaluation and Management
documentation guidelines to provide more time to revise and test
the guidelines and to educate physicians on the use of the guidelines.
The guidelines were scheduled to go into effect July 1, 1998.
In a letter to the American Medical Association (AMA), Nancy-Ann
Min DeParle, administrator, said, "Understandably, physicians
are reacting to flaws in the documentation guidelines that we
are committed to fix. I am directing carriers to continue to use
both the 1995 and 1997 guidelines, whichever is more advantageous
to the physician." She said Robert Berenson, MD, director
of HCFA's Center for Health Plans and Providers, will report in
the early fall on the status of the revision efforts and the projected
schedule for testing, refinement and physician education. The
letter was disclosed by Berenson April 27 at the AMA "fly-in"
of representatives of national and state medical societies and
officials of HCFA and Inspector General's Office (IG), of the
Department of Health and Human Services. The meeting was held
in Chicago to review physicians' concerns about the guidelines.
"I have heard that physicians believe the 1997 documentation
guidelines . are too complex and burdensome," DeParle said.
"The most troublesome concern is that some physicians believe
the new guidelines will divert too much physician time and attention
from patient care to paperwork. I believe we can and must work
together to improve the guidelines so they do not impose requirements
in excess of those associated with clinically appropriate medical
record-keeping practices." Addressing the issue of fraud
and abuse sanctions against physicians, DeParle said, "I
want to assure you that physicians will not be punished for honest
mistakes and we will not make referrals to the Office of the Inspector
General for occasional errors." She said carriers will be
reminded of HCFA's policy that referrals are to be made to the
IG for possible sanctions only after the carrier determines the
situation was not caused by error and there is evidence of intentional
improper billing practices.