Medicare communications miss the mark

GAO says Medicare guidance to physicians is often late, incomplete or wrong. Lawmakers and CMS are taking steps to correct problems.

By Markian Hawryluk, AMNews staff. Oct. 15, 2001.

Washington -- Physicians need clear, concise answers they can rely on from Medicare contractors, witnesses told a congressional panel considering regulatory relief legislation.

The hearing of the Ways and Means Committee's health subcommittee focused on a bill, by Reps. Nancy Johnson (R, Conn.) and Fortney "Pete" Stark (D, Calif.), that includes measures aimed at improving the way Medicare communicates with physicians and other health professionals.

The burden of trying to keep up with new regulations and routine paperwork simply to treat Medicare patients has been a frequent complaint from physicians, said William Hall, MD, president of the American College of Physicians--American Society of Internal Medicine.

"Medicare patients are the ones who suffer when physicians and their office staffs are diverted from patient care activities to unnecessary paperwork. The result can be long waiting times before being seen by the physician," Dr. Hall said. "And in the worst cases, it can literally shut down a practice for days."

Results of a probe by the General Accounting Office buttressed doctor complaints about Medicare directives. "Physicians often do not receive complete, accurate, clear and timely guidance on Medicare billing and payment policies," the report said. It cited shortcomings in print, electronic and telephone communication as the reason.

GAO looked at seven group practices served by three different carriers over three months. The practices received about 950 documents on health care rules and billing procedures. The vast majority, 90%, came from consultants or specialty societies seeking to explain the cryptic 10% that came directly from the Centers for Medicare & Medicaid Services or its contractors, the GAO stated. [...]