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A wide-ranging coalition of health care provider organizations has been organized to pressure Congress to reduce Medicare’s regulatory burden on physicians as part of a comprehensive overhaul of the Health Care Financing Administration. The main legislative vehicle is the Medicare Education and Regulatory Fairness Act of 2001, sponsored by Reps. Pat Toomey (R-PA) and Shelley Berkley (D-NV) in the House and Sen. Frank Murkowski (R-AS) in the Senate.
Given the Bush administration’s desire to reduce regulatory overload, many Washington insiders say physicians are in their best position in years to revamp many of the more onerous bureaucratic and enforcement problems facing them when it comes to regulatory issues. Among other changes, the bill would:
— Allow physicians to return overpayments they mistakenly received within one year without the fear of being targeted for an investigation or audit, as long as an audit or investigation hasn’t already been initiated.
— Curtail the use of extrapolation, a process by which carriers estimate the amount of an overpayment using a small sample of audited claims.
— Prohibit carriers from collecting alleged overpayments until physicians who have decided to dispute the audit findings complete the Medicare appeals process. This provision would not apply to fraudulent activity.
— Stipulate that providers would not have to adhere to proposed Medicare rules until they officially become final, and carriers wouldn’t be able to apply new rules retroactively.
— Bar carriers or fiscal intermediaries from collecting alleged Medicare overpayments from physicians or others while they are appealing audit findings.
— Require carriers or fiscal intermediaries to allow Medicare overpayments to be recouped from physicians or others through a repayment plan or deductions from future reimbursements.
— Enable physicians and others to legally challenge the constitutionality of Department of Health and Human Services regulations.
— Reallocate funds from current budgets of carriers and fiscal intermediaries to education efforts for physicians and other practitioners.
— Force HCFA to postpone implementation of its new evaluation and management documentation guidelines until it completes at least four pilot programs.
— Require HCFA to provide training to health care providers on the correct way to submit patient claims for reimbursement.