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.

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