Medicare Simplifies Enrollment Form
Takes Other Steps To Ease Regulatory Burden On Physicians
The Centers for Medicare and Medicaid Services (CMS) today announced a new,
streamlined enrollment form that will make it easier for qualified physicians
and other health-care providers to become eligible for Medicare reimbursement
for the care and services that they provide on behalf of Medicare beneficiaries.
Medicare will begin using the new user-friendly forms effective Nov. 1. The
forms reflect extensive input from physicians and allow doctors and other
providers to fill out only the portions relevant to their practices.
The new form is part of CMS' broader effort to be more responsive to the needs
of physicians and other health-care providers. CMS Administrator Thomas A.
Scully launched the agency's "Open Door Initiative" in July to reduce
unnecessary administrative burdens and to fulfill Health and Human Services
Secretary Tommy G. Thompson's commitment to create a culture of responsiveness
at CMS, which administers the Medicare program.
"This simpler form is the most recent result of our agency-wide efforts to
reduce Medicare hassles and let physicians and physician groups focus on patient
care, not paperwork," Scully said. "Our goal is to create a simpler, more
effective Medicare that makes it easier for our 40 million beneficiaries to get
the quality care and services they deserve.
In developing the new form, CMS began by analyzing enrollment data to determine
how long it took for an enrollment application to be processed, as well as any
reasons for processing delays. The agency found that the previous form was
confusing, causing applicants to omit information and resulting in delays in
processing. In addition to simplifying the enrollment form, CMS has tightened up
its internal deadlines for processing enrollment forms, requiring 90 percent of
applications to be processed within 60 days of receipt and 99 percent within 120
days.
"Enrollment is the 'handshake' for the business relationship between a
physician, supplier or provider and Medicare," said Timothy Hill, director of
the Program Integrity Group. "The new forms and expedited processing will make
it easier for physicians to begin caring for Medicare beneficiaries, while
allowing CMS to make sure that only qualified physicians are eligible to receive
taxpayer dollars."
"The activities of the Open Door Initiative are an example of CMS' increased
focus on improving relationships with the physicians and other providers who
care for Medicare beneficiaries," said Ruben King-Shaw Jr., CMS' deputy
administrator and chief operating officer, who chairs the Open Door Initiative
efforts for physicians. "In a short period of time, CMS staff, working closely
with our physician partners, have successfully chipped away at a laundry list of
physician complaints."
Recent policy changes include:
 | EASIER ACCESS TO BENEFICIARY ELIGIBILITY INFORMATION. Physicians
have had difficulty determining if a beneficiary is enrolled in the
Medicare+Choice or fee-for-service programs, making it hard to know what rules
apply to referrals for diagnostic tests, hospitalization and other services. A
recently released program instruction authorizes contractors to communicate
eligibility information to physicians and providers by telephone without
violating patient confidentiality.
|
| IMPROVED PROGRAM INTEGRITY OPERATIONS. CMS is responsible for
making sure that Medicare pays only for those services authorized by the
Medicare law. The agency is now implementing a new system for monitoring the
propriety of payments-the Comprehensive Error Rate Testing Program. "We
believe the new program will provide CMS with more useful information, with
less hassle for physicians and their office staff," says Hill.
|
| REDUCED FREQUENCY OF RE-CREDENTIALING FOR PHYSICIANS IN MEDICARE+CHOICE
PLANS, OTHER M+C IMPROVEMENTS FOR PHYSICIANS. CMS has extended from two
years to three the time period for plans to recredential their physicians to
be consistent with the national accrediting community. In addition, CMS has
clarified that not all physicians in a M+C network are required to have
hospital admitting privileges, so long as the plan has an adequate panel of
physicians with such privileges. Additionally, physicians in a M+C network
with provisional hospital privileges may care for patients while awaiting full
hospital privileges.
|
| SIMPLIER ADVANCE BENEFICIARY NOTICES (ABN) AND CLEARER GUIDANCE ABOUT
THEIR USE. The agency recently posted on its Web site new simplified ABN
forms that physicians may download and use. There is an ABN for general use,
an ABN especially designed for use with laboratory tests, and, at the request
of physician groups, an optional ABN that physicians can use to explain to
patients what services are never covered by Medicare. The agency has also
posted a set of Frequently Asked Questions, addressing such issues as the
proper use of ABNs in emergency rooms, the laboratory's v. the physician's
responsibility to execute an ABN, and patient questions about ABNs. These
materials can be found at:
http://www.hcfa.gov/medlearn/refabn.htm.
|
| CLARIFICATION OF POLICIES RE: PHYSICIAN ORDERING OF DIAGNOSTIC TESTS.
The agency has clarified Medicare policies regarding the ordering of
diagnostic tests, including diagnostic radiology and clinical laboratory
procedures, which play a central role in treating Medicare beneficiaries.
Specifically, effective Sept. 27, 2001, Medicare permits radiologists to
perform additional diagnostic tests, including diagnostic mammograms, when:
(1) there is an abnormal result on the ordered test; (2) the beneficiary's
treating physician or practitioner cannot be reached, and (3) delay would have
an adverse affect on the beneficiary's care. For surgical or cytopathology
specimens, Medicare now permits a pathologist to perform additional tests,
such as special stains, needed to make a complete and accurate diagnosis,
without separate authorization from the treating physician. For both radiology
and pathology procedures, the medical necessity of the additional tests must
be documented in t! he patient's record.
|
| EXPANSION OF MAMMOGRAM PAYMENTS. CMS has instructed contractors to
allow payment for screening and diagnostic mammograms performed on the same
day. Previously, when both tests were performed on the same day, only the
diagnostic procedure was eligible for Medicare reimbursement.
|
| CLARIFIED INSTRUCTIONS OF REPORTING RESULTS
OF DIAGNOSTIC TESTS. Physicians who follow
ICD-9-CM coding instructions sometimes are denied payment for medically
necessary services. New instructions, released on Sept. 26, 2001, provide a
stepwise approach and clarifications to coding for these services, helping to
assure that medically appropriate services are indeed paid for by the program.
|
| INFORMATION FOR PATIENTS THAT IS USEFUL FOR PHYSICIANS. The
Medicare & You beneficiary handbook is increasingly useful to clinicians as
well as the 40 million Medicare beneficiaries who routinely receive this
annual mailing. This year the agency developed a special Physician's Edition
of Medicare & You 2002, highlighting key information for physician practices
in a physician supplement that contains informative regulatory and policy
updates. This is currently in the mail to 600,000 participating physicians
around the country.
|
| ENHANCED ROLE OF PRACTICING PHYSICIANS IN POLICY DEVELOPMENT.
Physicians within and outside the agency have played important roles in CMS'
efforts to identify and eliminate unnecessary regulatory burden. CMS now
counts 45 physicians on staff in central and regional offices, a tripling of
the number of physicians at the agency in the past four years, and the
administrator's goal is to again double that number in the next year.
|
| PARTICIPATING IN PRECEPTORSHIP PROGRAMS ACROSS AMERICA. CMS staff
are also continuing to participate in preceptorship programs organized by
state and county medical societies. The most recent event was hosted by the
Philadelphia County Medical Society. The preceptorship programs give policy
makers in CMS the opportunity to "shadow" physicians in a variety of work
places, to gain a greater awareness of the impact of Medicare policies on
patient care. |
Back
|
