April 2001 Bulletin

Seek to ease Medicare rules

Bills give providers new appeals rights, limit ‘extrapolation’

Legislation that would ease the regulatory burden of Medicare regulations was introduced in the U.S. House and U.S. Senate in March.

The Medicare Education and Regulatory Fairness Act would create new appeals rights for providers who are audited by the Health Care Financing Administration and would delay demanded repayments until after appeals have been heard. The bill would limit HCFA’s use of "extrapolation" to increase repayments when a billing error is found and would require HCFA to provide training to health care providers on the correct way to submit patient claims for reimbursement.

The bill was introduced by Sen. John Kerry, (D. Mass.); Sen. Frank Murkowski (R-Alaska); Rep. Pat Toomey (R-Pa.); and Rep. Shelly Berkley (D-Nev.). It has the backing of dozens of health care groups and more than 50 organizations and the American Medical Association.

The AAOS has as one of its top priorities the reduction of Medicare regulatory burdens faced by physicians. Last year, the AAOS asked Rep. Donald Manzullo (R-Ill.) and Rep. Collin Peterson (D-Minn.) to circulate a "Dear Colleague" letter urging chairmen of key health committees to hold hearings on the impact of HCFA regulations on the practice of medicine. Largely through the efforts of the National Orthopaedic Leadership Conference more than 60 members of the House signed the letter.

Hearings were ultimately held by both the Commerce Committee and the Budget Committee where the AAOS submitted testimony and worked with committee staff to highlight many of the problems orthopaedic surgeons face.

The AAOS worked closely with Rep. Toomey and Sen. Murkowski in developing the bill. In introducing the legislation, Sen. Kerry said "the vast number of Medicare rules and regulations imposed on healthcare practitioners are bewildering and it’s the complaint of every practitioner at every level in the country. We are stifling the ability to provide good medical care in this country.

"All of us recognize the need to ferret out waste, fraud and abuse. We also have an obligation to ferret out stupidity and abusiveness."

Sen. Murkowski said "more and more often, seniors are being told by providers that they don’t accept Medicare.... Why? Well, it’s not as simple as low reimbursement rates. It is much more complex."

He said HCFA and its network of contractors, "have built up a system designed to block care and micro-manage independent practices. Providers simply cannot afford to keep up with the seemingly endless number of complex, redundant, and unnecessary regulations. And if providers do participate? Well, a simple administrative error in submitting a claim could subject them to heavy-handed audits and the financial devastation of their practice. Should we force providers to choose between protecting their practice and caring for seniors? I believe the answer is no."

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