May 2001 • Volume 7 • Number 5
Law could wipe out some burdensome Medicare regulations
A true story: A Medicare carrier audited a sample of 80 claims, looking for overpayments to the physician. The physician had to supply supporting records and documentation within 45 days.
Discrepancies and mistakes were found in some claims. The carrier estimated that the same proportion of errors occurred in all the physician's Medicare claims for a certain period. The physician therefore owed Medicare between $99,000 and $285,000 in overpayments, and the carrier demanded $99,000 within 30 days.
Tell your lawmakers why MERFA would make more physicians willing to care for Medicare patients.
The physician sought an extension. The carrier asked for letters denying loan applications, within 30 days. The physician's practice could not apply for loans and obtain responses by the deadline, so it paid the $99,000.
The physician appealed the audit findings. Three years later, a judge ruled there'd been no overpayment and refunded the $99,000.
That's the end of the story. But it's just the start of a new effort to make Medicare rules less burdensome. The Academy and 48 other medical groups sent the story April 3 in a letter to all members of Congress, asking them to cosponsor the bipartisan Medicare Education and Regulatory Fairness Act, H.R. 868 and S. 452.
MERFA would, for one thing, ensure that the physician in the case study above could go through an appeals process before being forced to repay the alleged overpayments, if the audit followed Medicare's first discovery of an error by the physician. MERFA also would:
- require HCFA and the carriers to construct effective, responsive education programs for physicians concerning Medicare regulations,
- stop carriers from demanding documentation on claims without cause, and
- allow physicians to waive a copayment when a Medicare patient cannot afford to pay.
Tell your lawmakers why MERFA would make more physicians willing to care for Medicare patients. See http://www.aafp.org/gov/fed/factsheets/merfa.html.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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