Debate continues on new E/M guidelines

Late 1999 is the likely effective date

After intense behind-the-scenes negotiations, the Health Care Financing Administration (HCFA) and the American Medical Association (AMA) have agreed to agreed to continue working on a set of new official guidelines physicians will use to document the provision of medical evaluation and management services (E/M) for Medicare reimbursement.

While an official date for implementing the new E/M guidelines has not yet been set, most insiders say it will be late 1999 before they go into effect. Meanwhile, HCFA policy permits physicians to use either the 1995 or the 1997 documentation guidelines as they see fit.

One area of contention between the AMA and HCFA is the future use of numerical formulas in evaluation and management documentation procedures. HCFA claims these techniques are necessary to ensure consistent interpretation of results by Medicare carriers.

Most provider groups disagree, however. "The AMA strongly regrets HCFA’s insistence on retaining some quantitative formulas," said Randolph D. Smoak, Jr., MD, chair of the AMA Board of Trustees, in a prepared statement. Signaling a willingness to compromise, HCFA has indicated it will consider minimizing the use of such formulas in any future evaluation and management guidelines.

"After intensive discussions with the Health Care Financing Administration, the AMA feels HCFA is responding to physician concerns and has agreed to work with the AMA and its CPT Editorial Panel on new evaluation and management documentation guidelines that are simpler and less burdensome than current guidelines or earlier proposed revisions," said Smoak.

"This issue is of critical importance to practicing physicians," he continued, "since these guidelines indicate the medical record documentation needed by physicians and claim reviewers to determine the level of evaluation and management service provided to patients in Medicare."