American College of Physicians: Internal Medicine — Doctors for Adults ®


New HCFA guidelines delayed for six months

From the January 1998 ACP Observer, copyright 1998 by the American College of Physicians.

Doctors have an extra six months to learn to use the new guidelines for documenting evaluation and management (E/M) codes in Medicare bills.

In response to concerns that doctors have not had enough time to learn to use the new guidelines, HCFA announced last month that it will require physicians to use them starting July 1. They were supposed to take effect Jan. 1.

HCFA officials emphasized that until then, it will still require that E/M services are medically necessary and supported by documentation in the patient's medical record. Meanwhile, some of the documentation guidelines are in the process of being revised.

Starting July 1, physician bills to Medicare will be audited both retrospectively and prospectively, and physicians will be denied payment for the billed service if they don't comply with the new guidelines.

For a summary of the guidelines, see articles in the November and December issues of ACP Observer, go to ACP Online ( or to HCFA's web page on the Internet (

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