AMA House of Delegates

AMA meeting: Penalize Medicare contractors for pay delays

■ Delegates also said the July 6 deadline for PECOS enrollment should be pushed back to the original January 2011 date.

By Kevin B. O’Reilly — Posted June 28, 2010

Chicago -- The House of Delegates directed the AMA to push for a raft of measures, including penalties for wrongly delayed payments, aimed at improving the performance of the Medicare administrative contractors that manage physician enrollment and process and pay claims.

The house adopted an AMA Council on Medical Service report that calls for better staffing and improved training at the firms and asks the Centers for Medicare & Medicaid Services to list publicly the standards used to measure contractors' performance.

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 ordered a transition from 43 contractors to 15, a change that delegates said has produced slow claims-processing, enrollment snafus and long customer-service waits.

Plastic surgeon Andrew Y. Kleinman, MD, said that 80% of his Medicare claims were rejected because of a scanner problem. When his office in Rye Brook, N.Y., called about 10 claims that had been denied, the contractor said they were allowed to only address five claims per call, even though all related to the same scanner problem.

"So we had to call again," said Dr. Kleinman, an alternate delegate for the Medical Society of the State of New York who authored a resolution at the 2009 Annual Meeting that prompted the council's report. "Their only recommendation was to file the claims again. If this is allowed to continue, our ability to care for Medicare patients will be severely diminished."

Delegates also said CMS should return the deadline for enrolling in the Provider Enrollment and Chain of Ownership System, known as PECOS, to Jan. 3, 2011. The agency said the deadline had to be pushed up to July 6 to comply with the health system reform law.

The house also said CMS should play fair with physicians whose Medicare billing privileges are deactivated on a technicality, such as a wrong office address. Doctors should get paid for the care they provided during the time their privileges were deactivated, delegates said.

ADDITIONAL INFORMATION

Meeting notes: Medical practice

Issue: Communication between patients and physicians is essential to good care. Interpreters often are needed for non-English speaking or hearing-impaired patients referred from emergency departments. Interpreting services usually are offered at a physician's expense and often cost more than the doctor is paid for his or her services.

Proposed action: Study the feasibility of requiring hospitals to provide and pay for interpreter services for the follow-up care of patients who physicians are required to accept as a result of a patient's emergency department visit. [Adopted]

Issue: Physicians in some individual and small practices will have difficulty meeting the proposed Centers for Medicare & Medicaid Services' meaningful use standards for electronic medical records, such as computerized physician order entry for 80% of patient services. Therefore, they will not receive the federal bonuses available for successful EMR adoption.

Proposed action: Work with the Dept. of Health and Human Services to improve the incentive requirements to maximize physician participation. [Adopted]

Issue: CMS relaxed the standards for physicians to qualify for bonus payments for electronic prescribing. However, it has not done so for the Medicare Physician Quality Reporting Initiative.

Proposed action: Ask Congress to delay mandatory physician participation in the Physician Quality Reporting Initiative until it is made more physician-friendly and reporting standards made less arduous. [Adopted]

Issue: Patients often have a poor understanding of proposed medical interventions' benefits and risks, and can have trouble visualizing how treatments could affect their lives.

Proposed action: Adopt policy recognizing the value of "shared decision-making" tools that help patients understand clinical information about their conditions, treatment options and potential outcomes while helping them integrate their personal values in making health care decisions. Payers should not require use of the decision aids, however, and the Association will support efforts to test the tools' effect and develop quality standards for them. [Adopted]

Issue: Many Veterans Health Administration patients are unaware of benefits available to them, especially prescription drug benefits. The number of enrollees in the VHA benefits plan is expected to increase by nearly 300,000 in 2011, when the VHA will open enrollment for Priority Group 8 veterans -- those with no service-connected disabilities and whose income and assets are above certain geographic thresholds. That could affect care delivery to veterans in Priority Groups 1 to 7.

Proposed action: Encourage the VHA to continue and strengthen its outreach and educational efforts to veterans already enrolled in its health benefit plans to increase awareness of the available benefits, including pharmacy benefits. [Adopted]

Issue: Physician rating websites have little policing to ensure that people posting to them are really patients and not imposters or competitors. The sites also do little policing of posters who make libelous or fraudulent statements. Physicians have little recourse to correct wrong information posted to the sites.

Proposed action: Work with Congress to enact legislation that would better police website operators. [Referred]