HCFA last week agreed to delay indefinitely implementation of new documentation rules designed to deter improper Medicare payments to physicians.
The move was a response to ongoing opposition from doctors, who say the rules are too complex and burdensome.
A longstanding Medicare regulation requires providers to maintain medical records that contain documentation to justify treatments billed to Medicare, but only in recent years has the government attempted to enforce it.
Two government audits covering fiscal 1996 and 1997 Medicare payments have drawn attention to inadequate documentation of physician services.
HCFA implemented an initial set of documentation guidelines in 1995. Last year it issued a new version that was greatly expanded to include the most costly physician services. Doctors were to implement the new guidelines in January, but in December HCFA issued a six-month grace period at the request of the American Medical Association (Dec. 22-29, 1997, p. 24).
In extending that delay indefinitely last week, HCFA said neither it nor the AMA "fully understood the magnitude of the problems." HCFA said more time is needed to revise and test the rules and to educate doctors and Medicare carriers.
The latest postponement was announced in Chicago, where about 300 leaders of organized medicine convened for one day at an AMA-sponsored "fly-in" to discuss their concerns with the rules.
Jane Orient, M.D., executive director of the Tucson, Ariz.-based Association of American Physicians and Surgeons, criticized the AMA for cooperating with HCFA to develop the guidelines. Her group has threatened to sue HCFA and the AMA, claiming the rules are unconstitutional because they violate free speech, protection against unreasonable searches and due process rights of doctors.
Despite such criticism, even from its own members, AMA leadership has maintained that the documentation guidelines are inevitable and that physician input will result in a better product.
In a letter to AMA President Percy Wooton, M.D., HCFA Administrator Nancy-Ann Min DeParle tried to put to rest concerns that doctors would be targeted for fraud and abuse prosecution if they fail to follow the guidelines correctly.
HCFA is allowing doctors to use either existing guidelines or the proposed new version until revisions are completed.