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Government wants to know what doctors think about program

Mississippi physicians want fixes in Medicare program

Calling all physicians. The federal government wants you — to give your opinion, that is, on the country’s Medicare program.

In an effort to eliminate waste and bureaucratic delays in the Medicare system, the House Committee on Energy and Commerce is asking physicians to fill out a survey on their experiences with Medicare and its governing agency, the Health Care Financing Administration (HCFA).

Fed up with what they claim are hard-to-understand rules, mountains of paperwork and fear of penalties, Mississippi doctors say they are happy to help.

“HCFA has taken a repressive approach,” said Dr. Hugh Gamble of Greenville who is president of the Mississippi State Medical Association (MSMA). “They’re approach is, ‘We’ve told you what the rules are and anytime there is a deviation, that’s fraud.’ The response is a visit from the U.S. Attorney’s office.”

Gamble said HCFA’s rules and regulations come in a book “that would dwarf the New York phone book,” and physicians he has talked with find these rules confusing and time-consuming.

“We almost need another year of medical school to teach us how to do the coding,” said Dr. John Cook, an OB-GYN with Jackson Healthcare for Women. “That is not why we got into medicine.”

Physicians say they know that a pattern of mistakes in billing could result in penalties and imprisonment, but because the rules are hard to keep up with in the over-110,000-page HCFA rule book, they may be making mistakes they don’t know about.

“It puts fear into your heart,” said Vicksburg surgeon Dr. Briggs Hopson, director of River Region Medical Corp. in Vicksburg. “If the paperwork isn’t filled out properly, they think you’ve committed a crime. It’s like Big Brother — they’re always looking over your shoulder.”

There are bad apples in the bunch, acknowledges Hopson, but a doctor who innocently assigns the wrong codes to his diagnoses for several years in a row could face the same penalties as another doctor who deliberately commits fraud.

Rather than take a “guilty until proven innocent” approach, Hopson would like to see HCFA handle suspected fraud in a different way. His suggestion is HCFA notify the non-compliant physician, show him what he is doing wrong, and offer educational courses. Continued non-compliance would then result in a penalty.

Educational courses straight from HCFA would be beneficial to doctors because of the complexity of the laws, said Hopson. Doctors take courses sponsored by medical societies and other groups, but interpretation of the law is sometimes different — putting doctors back to square one with risk of noncompliance.

The American Medical Association (AMA) worries that if HCFA billing problems are not addressed, Medicare patients could suffer. Testifying on Capitol Hill recently, AMA president-elect Richard F. Corlin said doctors are becoming more and more reluctant to accept new Medicare patients.

Physicians in rural areas will accept Medicare patients because they need the business, agreed Cook, but physicians in populous areas with plenty of patients might decide they don’t need the paperwork hassle and risk of getting into trouble.

Further compounding the problem is low Medicare reimbursement from HCFA, said Cook. With the amount of hours a physician spends treating the patient and complying with HCFA rules, it is not advantageous for physicians to have a large amount of Medicare patients.

“We lose money taking care of these patients,” said Cook. “From a business standpoint, it really hurts.”

Another problem Gamble sees coming down the road is the reluctance of young doctors to start a new practice. Not wanting to deal with the alphabet soup of compliance — HCFA, OSHA, ERISA, etc. — many will choose to be employed by a corporation, said Gamble.

Legislation now before Congress promises to fix many of problems that physicians encounter with Medicare. The Medicare Education and Regulatory Fairness Act of 2001, known as MERFA, calls for funding for education programs on documentation and billing, and faster response to physician reimbursement questions. MERFA would allow a physician to contest an overpayment judgement and submit additional information, without waiving their appeal rights. It would also require that a fair determination of a case be made before alleged overpayments are to be repaid. Under current law, repayments are due in 60 days, even if the physician wants to appeal.

Gamble said he is optimistic MERFA will pass based on conversations he has had with lawmakers connected with the legislation. Also promising is the fact that the federal government is asking for physicians’ opinions through the survey, he said.

“I don’t recall the government ever asking for grassroots input from physicians,” he said. “You could at least look at that optimistically.”

Physicians can fill out the Medicare survey on the Internet at www.house.gov/ commerce/hcfasurvey.htm or call the Committee on Energy and Commerce at (202) 225-2927.

Contact MBJ Staff Writer Kelly Russell Ingebretsen at kelly@msbusiness.com or (601) 364-1027.


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