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

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Medicare to improve education, policy development

From the February 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

By Brett Baker

Q:

I heard that Medicare is trying to determine how to improve the way it provides educational billing and coding information to physicians. How can I provide input?

A:

HCFA hired Aspen Systems Corporation to develop a plan to improve how Medicare carriers educate physicians about billing and coding procedures. Aspen will develop the plan using focus groups, carrier interviews, survey results and input from medical organizations. The College believes that HCFA needs to help physicians submit initial claims correctly so they can avoid time-consuming follow-up interactions.

Aspen has conducted focus groups across the country to ascertain what types of educational information physicians find helpful. Focus group participants requested easily accessible, authoritative information; easier processes to resolve denied or rejected claims; more specialty-specific billing and coding materials; and improved carrier educational programs.

Aspen is in the process of interviewing Medicare carriers about their current provider education efforts. ACP-ASIM asked Aspen to focus on carrier deficiencies in addition to best practices.

This spring, Aspen plans to survey a national sample of 9,000 practitioners and providers who participate with Medicare (excluding hospitals). ACP-ASIM helped Aspen identify topics to be addressed in the survey. Aspen anticipates that the survey will take 20 minutes to complete. If you receive the survey, please complete it.

ACP-ASIM intends to provide input throughout the provider education project. Send your recommendations for improving carrier billing and coding educational materials to me. (Contact information appears at the end of this article.)

Q:

How has the process by which carriers develop local policies changed?

A:

HCFA has instructed its carriers to change the way they develop state-specific policies, known as local medical review policies (LMRPs) by opening the process to public input. Physicians currently have input into these local policies through their state carrier advisory committee (CAC), which is made up of representatives from each major medical specialty and the state carrier medical director. Specific changes that open the CAC process are described below.

  • Starting January 2001, carriers had to post draft LMRPs on their Web sites. Before these draft version are presented to the CAC, carriers must hold a meeting open to public comment. Carriers will then present relevant information from the open meeting to the CAC.

  • Starting February 2001, each carrier must post on its Web site a summary of the comments it received from the public and the CAC. This summary must include the carrier medical director's rationale for accepting or rejecting the comments.

  • Starting April 2001, carriers must list on their Web sites the status of all LMRPs. This will give interested parties a chance to review proposed LMRPs, learn where to send comments about the proposals, view finalized policies and see the implementation date of new policies.

Brett Baker is a third-party payment specialist in the College's Washington Office.

If you have questions about third-party payment or coding issues, contact him at 202-261-4533 or bbaker@acponline.org.

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