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

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Policy briefs

From the September ACP Observer, copyright 2003 by the American College of Physicians.

ACP objects to onerous Medicare billing privileges proposal

The College has asked the federal government to not implement a proposal that would require physicians to take additional steps to apply for—and regularly update—their Medicare billing privileges.

The Centers for Medicare and Medicaid Services (CMS) has proposed requiring physicians who enrolled in Medicare before the current enrollment application was introduced in 1996 to fill out a new application. The agency also wants to require all physicians to promptly report changes to enrollment information on file, and to revalidate information every three years.

In a June 24 letter to CMS Administrator Thomas Scully, the College complained that the process would be intrusive and burdensome for physicians, forcing them to spend yet more time collecting information and filling out forms to participate in Medicare.

The letter said that the agency has not provided any evidence that the additional steps are necessary or would help Medicare prevent fraud and abuse. Data used to support more stringent requirements to establish and maintain billing privileges pertain almost entirely to nonphysician providers, the letter stated.

The letter is online.

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College supports bill to create health care workforce commission

ACP is supporting legislation that would create a commission to analyze federal health care workforce policies.

In an Aug. 6 letter to Senate leaders, ACP said it supported the Health Workforce Advisory Commission Act of 2003 (S. 1498). The bill would gather, analyze and formulate federal workforce policies that address forecasting the health workforce; financial incentives to promote the education of health care professionals; the role and global implication of international medical graduates; and achieving diversity in the U.S. workforce.

The College pointed out that medical students are losing interest in primary care careers. The College cited statistics from the Association of American Medical Colleges' exit surveys of medical students showing that the number of students planning to choose careers in general internal medicine dropped from 12.2% in 1999 to 5.9% in 2002.

In addition, this year's Match results showed that 194 fewer U.S. medical graduates chose the categorical primary and medicine-pediatrics internal medicine programs, the letter said. That number represents a 6% drop from last year.

The letter is online.

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College to Senate: Help fund technology to improve patient safety

ACP is calling on the Senate to include funding for health care information technology in the Patient Safety and Quality Improvement Act (S. 720).

In a July 23 letter to members of the Senate Health, Education, Labor and Pensions Committee, ACP joined 39 other organizations in asking legislators to fund information technology for physicians, hospitals and other health care organizations.

The letter pointed out that evidence has shown that information technology can reduce medical errors and improve the quality of health care. It also noted that the health care industry has been slow to adopt technology, in part because physician practices cannot afford to invest in the technology.

Earlier this summer, HHS announced that it is getting involved in the effort to help medicine embrace electronic medical records software. HHS directed the Institute of Medicine and a standards group to develop a model electronic medical record system that everyone in the U.S. health care system can use free of charge.

The College's letter is online.

Physicians must file claim form for Aetna settlement by Sept. 30

If you have cared for patients insured by Aetna since 1990, you have until Sept. 30 to claim your share of a settlement from a class-action lawsuit.

In June, a federal judge approved a $170 million settlement in which the insurer will pay $100 million to physicians and use $20 million to create a foundation to improve the quality of health care. (About $50 million will be used to pay attorneys' fees.)

The class-action lawsuit was created by consolidating various lawsuits against U.S. insurers. Many of the lawsuits charged insurers with reducing physician pay and interfering with patient care.

In addition to paying physicians, Aetna promised to make other changes in the way it reimburses physicians and approves treatment. Officials estimated that those changes would be worth $300 million to physicians over several years.

Physicians who agree to the settlement will be paid based on the dollar amount of services they billed the insurer in a consecutive three-year period between 1990 and 2002. Settlement amounts will be tiered, and physicians who billed for more than $50,000 of services during that period will receive the greatest share of the settlement.

You can identify the three-year period that will give you the highest settlement, but you must provide documentation to show your activity during those years. If you don't specify a period, your settlement will be calculated based on the services you billed for between 2000 and 2002.

If you accept the settlement, you waive your right to pursue most claims against Aetna that originated between August 1990 and June 2003. Physicians who take no action at all will still be covered by the settlement, and their share of the settlement will automatically be given to the foundation to improve the quality of care.

More information about the settlement and a claim form is online.

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