Medicare regulatory relief: Doctors see good in House, Senate reform bills

Physicians can expect better carrier relations and improved appeals and due process rights.

By Markian Hawryluk, AMNews staff. July 21, 2003.

Washington -- While congressional debate over Medicare payment provisions, managed care choices and prescription drug coverage continues to be rancorous, a group of often overlooked provisions in the Medicare reform bills is virtually assured of approval. The package could have profound impact on physician practices.

Both House- and Senate-passed versions of the Medicare reform legislation include extensive sections that would provide regulatory relief for physicians. Although each version contains physician-supported provisions that the other does not, physician groups are ecstatic that both chambers have passed meaningful reforms.

AMA Trustee J. Edward Hill, MD, said he expects that the conference committee of House and Senate negotiators will have little difficulty in reaching a final compromise on the paperwork reduction measures.

"We've got good things in both packages," Dr. Hill said. "What we're hoping will come out of the conference is a consolidation of the good things of both of these bills that give us some regulatory relief."

For example, physicians favor a Senate provision that would ensure a carrier medical director in every state. The Centers for Medicare & Medicaid Services had indicated it might consolidate the number of directors into fewer regional positions. That move would reduce physicians' ability to impact carrier decision-making, Dr. Hill said.

Physicians have been clamoring for years for limits on the use of extrapolation, a process by which carriers calculate an overall level of errors and overpayments from a small sample of physician claims. But only the House bill would limit extrapolation.