December 1997 AAOS Report

Academy joins suit against PATH audits

The Academy has joined the American Medical Association (AMA), American Hospital Association, Association of American Medical Colleges and a number of hospitals, academic health centers and national specialty societies in their lawsuit against the U.S. Department of Health and Human Services (HHS). The case asks the federal district court in Los Angeles to end "unfair and retroactive audits" of teaching physicians' Medicare billing practices involving residents. In July 1996, the Health Care Financing Administration (HCFA) issued new rules outlining the documentation required in order for teaching physicians to bill Medicare for the services of a resident under their supervision. As a result, the Office of the Inspector General of HHS began auditing and penalizing physicians who did not follow these new coding requirements prior to HCFA's announcement even though the regulations were not yet in effect. The complaint alleges that HHS, under its Physician at Teaching Hospitals (PATH) initiative, aims to coerce institutions into "highly disadvantageous and unfair voluntary settlements based on unlawful and retroactively applied standards." The medical groups are asking for an adequate period of time to allow teaching hospitals to develop and implement corrective actions to assure voluntary compliance with the new requirements for documentation of physician services.

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