June 2001 Bulletin

Orthopaedists urge support for MERFA bill

Legislation would attempt to create nonadversarial approach on Medicare coding, billing

John D. Hsu, MD, left, and Vernon T. Tolo, MD, right, meet with Rep. Adam Schiff (D-CA) to discuss MERFA bill, during the annual National Orthopaedic Leadership Conference in Washington, D.C.

Patient care, not paperwork. That was the message carried by hundreds of orthopaedic surgeons who made their way to Capitol Hill in Washington, D.C. in April. The visits to the offices of legislators were part of the annual National Orthopaedic Leadership Conference, which this year was attended by a record 200 orthopaedists, including the AAOS Board of Directors, Board of Councilors, COMSS, specialty societies and state societies.

The main objective of the "Hill" visits was to obtain support for the Medicare Education and Regulatory Fairness Act of 2001 (MERFA). The legislation (H.R. 868 and S. 452) makes important changes to Medicare operations in an attempt to create a more inclusive, nonadversarial system for addressing the complexities of Medicare coding and billing requirements and related regulations imposed on physicians, hospitals and other providers.

Legislators were told that the legislation is needed because physicians face many confusing and sometimes contradictory regulatory requirements of HCFA. Compliance with these regulations detracts from time that physicians have to treat patients. While the overwhelming majority of physicians are honest and provide important services to patients each day, the complexity of the current system sometimes leads to innocent billing and coding mistakes.

To address these unintentional errors, the orthopaedists said HCFA uses aggressive government investigations such as post-payment audits rather than spending time educating physicians on proper coding, billing and documentation techniques.

Passage of MERFA would reduce the regulatory burdens faced by physicians by shifting the focus from a punitive enforcement approach to one of communication and education—allowing physicians to concentrate on treating patients. The legislation takes steps to assure physicians that they will not be investigated, harassed or prosecuted because of good faith efforts to comply with Medicare’s administrative and regulatory requirements. Significant components of the legislation are to:

MERFA legislation leaves intact the current laws that the government relies on to eliminate fraud and abuse, but ensures that physicians and other providers are not unduly targeted for innocent mistakes. Changes in the audit process and a shift toward better communication and education between Medicare carriers and physicians should lead to a reduction in billing and coding errors, while allowing more time to focus on patient care.

Orthopaedic surgeons also urged their legislators to revisit the patient privacy final rules which also place unreasonable administrative burdens on physician practices, and may have a negative
impact on clinical research in this country. Both of these issues can be viewed as unintended consequences from the passage of the Health Insurance Portability and Accountability Act (HIPAA) in 1996, and the result has been interference with quality patient care.


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