June 2001 Bulletin

Tells of paperwork ‘nightmare’

HCFA should defend scope of record keeping, reporting


Alan H. Morris, MD, chairman of AAOS Council on Health Policy and Practice, left, discusses paperwork problem with Rep. Donald Manzullo (R.- IL), chairman of House Committee on Small Business

The growth in Medicare regulations generated from the Health Care Financing Administration and requirements from the Medicare fiscal intermediaries and the carriers has created a "bureaucratic nightmare of paperwork" for physicians, Alan H. Morris, MD, chairman of the AAOS Council on Health Policy and Practice, told a congressional committee last month.

"Our number one concern is the quality of orthopaedic care that we provide to our patients," Dr. Morris said at a hearing held by the U.S. House Committee on Small Business. "We believe that the health care infrastructure of this country is in critical need of an overhaul. We have lost sight of ensuring quality patient care and have managed to create a bureaucratic nightmare of paperwork, rather than focusing on spending time with patients. Both the federal government and private insurance providers should be focused on directing resources to ensure an appropriate balance of paperwork to patient care."

Dr. Morris said the AAOS encourages the committee "to challenge HCFA to demonstrate the necessity for the scope of record keeping and reporting now required by HCFA as well as the Medicare fiscal intermediaries and carriers. HCFA should be required to justify these requirements from a cost-benefit and quality patient care perspective."

The AAOS stresses the need to streamline, simplify and consolidate the forms and reports that must be completed. "We are also concerned that HCFA may be liberally applying exemptions under the Administrative Procedures Act and other laws to circumvent the review and clearance procedures required to approve regulations effect paperwork reporting and record keeping requirements," Dr. Morris said.

He reviewed many of the paperwork burdens including Medicare carrier reporting requirements and the fact that they operate with a great deal of discretion, the Medicare enrollment process and the Evaluation and Documentation requirements.

In his recommendations, Dr. Morris said, "it seems to make sense that third party intermediaries should be covered under the same laws as the federal agency they answer to. This can ensure appropriate and consistent communication and uniformity in policies and practices, while streamlining paperwork requirements for reporting and record keeping responsibilities." The AAOS suggests that Medicare third party intermediaries come under the Paperwork Reduction Act as agents of HCFA.

"Forms and data collection requirements initiated by Medicare carriers should be subject to review by the Office of Information and Regulatory Affairs in the Office of Management and Budget as established by the Paperwork Reduction Act," Dr. Morris said. "This holds true for many of the forms also generated directly by HCFA. Providers also do not get to adequately comment on the appropriateness of these Medicare forms that are generated out of HCFA headquarters. The review process should be scrutinized for its reasonableness and timeliness.

"HCFA policy and regulations should also be scrutinized for compliance with the Regulatory Flexibility Act. This law requires independent regulatory agencies and executive agencies to prepare analyses indicating how their regulations would impact smaller entities, including businesses.


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