The Medical Group Management Association is drafting legislation to blunt a federal crackdown on Medicare billing by teaching physicians.
New billing requirements threaten the future of academic medicine, MGMA officials said last we ek at the group's 70th annual conference in Minneapolis.
They said the rules, which pertain to services provided by residents, undermine the tradition of graduated responsibility for doctors in training and force teaching physicians to duplicate the work of residents.
"The result is an American public faced with either a generation of new physicians who are undertrained or medical schools that are financially failing," said Thomas Adams, the MGMA's executiv e vice president and chief operating officer.
The MGMA wants to have legislation introduced in Congress in January to void HCFA's so-called "elbow-to-elbow" policy. That policy allows teaching physicians to bill for services only if they are present for the key portion of the service. Under the policy, imposed July 1, both the resident and the teaching physician must document the teaching physician's presence.
The association said teaching physicians should be required to direct residents and document their involvement with each patient, but they should not be required to attend and document all services rendered.
The MGMA also wants to rein in an ongoing review of teaching physicians' compliance with billing procedures by HHS' inspector general's office. Faculty practices at the Hospital of the University of Pennsylvania and Thomas Jefferson University, both in Philadelphia, agreed to pay multimillion-dollar se ttlements, and about 25 more institutions have been notified of an audit.
The association opposes hefty penalties such as the double and triple damages paid in the Philadelphia settlements and said the government is retroactively ap plying the physical presence and documentation policies.
"Our concern is (that) the tenor of the audits suggests our physicians are fraudulent from the beginning unless we prove otherwise," said Robert Wright Jr., president of the MGMA's academic practice assembly. Wright is also president and chief executive officer of University Health Associates in Morgantown, W.Va.
"There must be a way honest billing mistakes can be corrected in a less severe and punitive manner," Adams said.
An HHS official said evidence suggests there is "a chronic problem" with adherence to the government's billing guidance (Sept. 23, p. 12). However, the MGMA said HCFA regulations have been ambiguous.
The Association of American Medical Colleges, also irked about HCFA's crackdown, might join the legislative effort if its quest for an administrative remedy fails, according to its regulatory counsel, Ivy Baer.
About 2,000 of the MGMA's 1 7,500 members are administrators in academic practices.