September 2000 • Volume 6 • Number 9
HCFA responds to physicians' concerns about fraud/abuse audits
Your Medicare carrier tells you your billing's incomplete. Or your carrier says you're overbilling. You disagree. You get audited. And you fear penalties if it's discovered that you or your staff made a few honest mistakes.
Frustration with the Medicare watchdog has led physician organizations, including the AAFP and the AMA, to urge the government to adopt a more sensible approach to preventing fraud and abuse.
Now, a breakthrough: Someone's been listening.
On Aug. 7, the Health Care Financing Administration issued a program memo requiring carriers to take "corrective action." A few corrections carriers must make:
- Validate potential problems by taking a sample of claims (up to 40) to see whether a physician is filing claims in error.
- Subject providers only to the amount of medical review necessary to address the nature and extent of the problem.
- Consider the provider's current error rate and the history of the provider when deciding how to address the problem. (In other words, it's now harder for carriers to go after physicians with clean records.)
- Educate the provider and give feedback about the problem.
- Remove providers from medical review as soon as possible when they demonstrate compliance with billing requirements.
"We need a fair and just system," says AAFP President Bruce Bagley, M.D., of Albany, N.Y. "HCFA's memo indicates the government appreciates what we've been saying: It's time to stop harassing well-intentioned physicians and focus on deliberate institutional fraud and abuse."
Order from AAFP at (800) 944-0000 unless otherwise noted.
Enroll now in the AAFP Proficiency Testing program for 2001 to help keep your lab in compliance with federal regulations. New modules include tests for blood lead, Mycoplasma antibody, Giardia antigen, sickle cell and special immunology. For annual enrollment (#R767), costs vary from $50 to $70; prices also vary for lab testing packages. See http://www.aafp.org/pt or call (800) 274-7911 for more information.
Are you part of the handheld computer generation? If so, you can get a little help at http://www.aafp.org/fpnet -- the FPNet Web site. Read articles on palm computers in clinical practice, and then click on "Hardware" and visit Web sites on personal digital assistants.
Family practice brochures promote the specialty to patients. Order "Today's Family Physician: Specializing in All of You" (#R013); "Managed Care and Your Family" (#R014); "Compassion, Caring, Competence: Family Physicians Are the Medical Specialists for the 21st Century" (#R015); and "Obstetrical Services Provided by Your Family Physician" (#R024). Get 100 copies of any brochure for $28.
Proven value: Get the updated 2000-01 Tar Wars program curriculum so you can present the tobacco-free education program to fourth- and fifth-graders (#958, free). For details, visit http://www.tarwars.org or call (800) TAR WARS [827-9277].
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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