AAOS Bulletin - April, 2005

PRIT works for physicians on Medicare issues

The Physicians’s Regulatory Issues Team (PRIT) is a part of the Centers for Medicare and Medicaid Services (CMS) that many physicians may be unaware of, even though its sole purpose is to reduce the regulatory burden on physicians who participate with the Medicare Program.

Under the direction of William Rogers, MD, FACEP, PRIT is composed of CMS subject matter experts who work closely with physicians who care for Medicare beneficiaries. Members of the team come from the CMS leadership staff, physicians, technical experts and regional office staff.

PRIT helps to amplify the voice of the practicing physician in several ways. Dr. Rogers, whose background is in emergency medicine, is active in the Open Door Forums and the Practicing Physicians Advisory Council (PPAC) sponsored by the CMS. The PRIT Web site (http://www.cms.hhs.gov/physicians/prit) includes numerous links and a tracking report that regularly updates the status of problematic issues.

Most recently, PRIT has been active in monitoring the processes being developed for physicians to obtain a National Provider Identifier (NPI), as mandated under the Health Insurance Portability and Accountability Act. The NPI, a numeric 10-digit identifier, is designed to replace the multiple identification numbers currently used by health providers in transactions with various health plans.

Providers may begin applying for their NPI on May 23, 2005; the deadline for obtaining an NPI is May 23, 2007. PRIT is following the discussions closely to ensure that the application process is simple and efficient.

Other options for feedback

PRIT is just one of several ways that CMS encourages physician participation and feedback. Another option is the Physicians and Allied Health Open Door Forums, monthly conference calls hosted by senior CMS staff. The forums cover issues of concern to participating providers. Physicians and their colleagues are welcome to bring their Medicare problems to the conference call where they can often be resolved in real time. The Open Door Web site can be found at: http://www.cms.hhs.gov/opendoor/

PPAC is a congressionally mandated advisory group on proposed changes in regulations and carrier manual instructions related to physicians’ services. Council members listen to testimony, respond to CMS requests for assistance and provide invaluable advice and input on how CMS rules and regulations affect today’s practicing physicians. The Council meets quarterly and consists of 15 Medicare participating physicians. The PPAC Web site can be accessed at: http://www.cms.hhs.gov/faca/ppac/

Medlearn Matters is an online educational service to keep physicians and their staff informed about changes to the Medicare program as well as clarify confusing rules. It can be accessed at http://www.cms.hhs.gov/medlearn. A listserv notifies provider/subscribers when a new article is released.

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