Letters to the Editor - Jan. 31, 2005

Medicare's statistic doesn't tell whole story of insufficient documentation - If it is OK to fingerprint physicians, then why not do it to everybody? - With HSAs, expect calls to cut fees

Medicare's statistic doesn't tell whole story of insufficient documentation

Regarding "Medicare zeroes in on E&M coding as key source of payment mistakes" (Article, Jan. 3/10):

The highlighted box shows "Failure to back up claims with sufficient documentation" as the largest problem, responsible for 43.7% of errors. Not providing sufficient documentation does not mean that the claim was unjustifiable. In fact, in our experience, even providing all requested documentation may not save you from being labeled as having failed to comply.

In 2002, certain claims in our specialty were under review, and we received an unusually high number of information requests. We received these requests after filing the claims; we were not given prior instruction to submit concurrent information with any claims.

These requests were crafted as form letters, easy to send but very burdensome and time-consuming for our staff to comply with, because of the volume of information that could be requested by the mere act of checking boxes like "Document all medications and surgeries" for very sick hospitalized patients with 6-inch thick charts. Nevertheless, our staff researched patient charts, copied pages and sent them to the designated reviewers.

In many cases, the response was simply the same letter again, as if we had never sent anything.

My office manager was tearing her hair out. We called the medical director, who checked with the nurse reviewers. They agreed that we had sent them so much stuff that we had overwhelmed their resources with our response.

We asked them to please communicate with us as to exactly what they were trying to determine, and maybe we could just give them a straight answer to a straight question.

The next thing we heard was that they decided that they should have just paid the claims in the first place, so they did.

But Medicare wasn't done with us yet. In 2003, we received a letter from the regional office notifying us that our claims of the previous year had been audited, and as a result we were on record for failing to provide adequate documentation for our services!

Stunned, I called the provider relations representative for the region and objected.

I told her that we had provided all documentation that had been requested, which she could verify by talking to the nurse reviewers in our area. I told her that providing all the documentation requested was very time-consuming and burdensome for my staff, so we were not likely to forget it.

I was floored at her response. Sternly, she told me that it didn't matter that we had sent all the requested information. Since we did not send the information with the original claims -- before it was requested! -- we were considered to have not provided it at all, at any time. Furthermore, nothing could change that formal determination regarding our claim history.

So, that is my perspective of the convenient manner in which Medicare stacks the numbers to make it appear that physicians are noncompliant.

--E. A. Smith, MD, Baton Rouge, La.

If it is OK to fingerprint physicians, then why not do it to everybody?

Regarding "Criminal checks increasingly a fact of life for physicians" (Article, Dec. 20, 2004): I am a little disappointed at the fact that AMNews represented this article in such a one-sided manner. It seemed that it was a foregone conclusion that physicians accept fingerprinting for the greater good.

I reject fingerprinting as a matter of routine screening, and I believe it is an important privacy issue that does not evaporate just because I am a physician.

Why does it seem so easy for those of us who do make sacrifices for the greater good to forsake our own rights? Would the same lack of reaction occur if I were to suggest that in states that require a physician to be fingerprinted that all patients who come in for care be fingerprinted at the same time?

I am sure you can imagine the outrage if we were to try to fingerprint the population getting driver's licenses. Isn't there a security issue there as well? By the same argument, wouldn't the greater good be served if we were to forsake individual privacy at this level as well?

--Daniel J. D'Arco, MD, Pottsville, Pa.

With HSAs, expect calls to cut fees

Regarding "Inform your patients about HSAs" (Editorial, Dec. 20, 2004): Your editorial on health savings accounts bears the good news that there is light at the end of the tunnel that has impeded both good physician-patient relationships and good medicine.

There is a problem: It will not work unless patients -- who are going to be charged retail fees by doctors and hospitals that are many times more than what they get from the government and insurers -- learn to bargain.

Are we ready to give discounts for cash payments and better relationships with our patients?

--Olgard Dabbert, MD, San Diego