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.

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