*This is an archive page. The links are no longer being updated. 1992.10.05 : Medicare Administrative Burden Contact: Bob Hardy (202) 690-6145 October 5, 1992 HHS Secretary Louis W. Sullivan, M.D., today outlined ongoing efforts to eliminate unnecessary administrative burdens placed on physicians by the Medicare program. "Physicians need to devote their time and energy to their patients, not unnecessary paperwork," Secretary Sullivan said. "As a physician who is familiar with the administrative tasks of running a medical office, I know the importance of reducing the extra load." In 1991, Secretary Sullivan created the Advisory Committee on Medicare-Physician Relationships, which included eight physicians. Last May, the advisory committee's report was issued, including recommendations for alleviating administrative burden. Many of the efforts outlined today respond to these recommendations. In particular, Dr. Sullivan said the Health Care Financing Administration -- the HHS agency that directs Medicare -- is making an extra effort to improve the physician's working relationship with Medicare carriers, which process claims. HCFA, which handles about 600 million Medicare claims annually for nearly 36 million beneficiaries, also is striving to reduce problems in claims processing, medical review and peer review organizations. Actions include: - More - - 2 - CARRIERS . HCFA is requiring each carrier by Oct. 1 to create a physician advisory committee, which will be composed of the medical directors of carriers and peer review organizations, presidents of state medical associations, physicians who treat Medicare beneficiaries and the beneficiaries themselves. The new committees will focus on improving physician-carrier relations through physician input into policy decisions and better explanations of these decisions. . HCFA will conduct a pilot survey to be released in October with a sample of 500 physicians in five states to get information from their perspective about carrier performance. HCFA currently conducts an annual review of each carrier's performance, known as the Contractor Performance Evaluation Program. CLAIMS PROCESSING . HCFA is working with insurance companies and physicians to develop industry-wide uniform insurance forms and electronic formats. That compares with today's 400 different electronic formats. . HCFA will eliminate first-claim development for Medicare secondary payer, using an initial enrollment questionnaire instead, to reduce payment delays. . HCFA will make administrative changes to claims processing on a quarterly basis, rather than irregularly. . HCFA has established a longer list of physician specialty designations at all carriers to avoid inappropriate denials for concurrent care. That can arise when a patient is treated by two physicians listed as having the same specialty. For example, under the new procedure, two specialists, formerly listed only as internists, could be redefined into their specialties, such as cardiology and urology. MEDICAL REVIEW . HCFA has increased the time allowed to medical societies to comment on changes in medical review policy. . HCFA is continuing work on clarifying the reasons for downcoding as displayed in remittance advices to physicians. HCFA will revise the entire remittance advice in fiscal year 1993. - More - - 3 - PEER REVIEW ORGANIZATIONS . HCFA has eliminated the requirement that physicians obtain approval from peer review organizations for certain surgical procedures, such as cataract surgery, before they are performed. . HCFA is conducting a pilot study to increase the coordination between PROs and carriers to resolve discrepancies in coverage policy and improve coordination of medical review. . Dr. Sullivan also said HCFA is making "a significant change in PRO focus from dealing with individual clinical errors identified through care review to helping physicians and hospitals improve the mainstream of medical care." "PROs will primarily analyze patterns of health care and patient outcomes, sharing this information with providers and their staffs to help them identify ways to improve quality of care and patient outcomes," Secretary Sullivan said. In addition, HCFA has established a permanent Practicing Physicians Advisory Council, consisting of 14 physicians representing various specialties and geographic areas, to advise the HHS secretary on proposed changes in instructions and other Medicare regulations related to physicians. "This committee, which was mandated by the 1990 budget law, provides physicians with a greater opportunity to affect the Medicare program," Acting HCFA Administrator William Toby Jr. said. Since its formation in 1965, Medicare has undergone great change in the number of beneficiaries and in its technical complexity. "That has added to the administrative requirements for physicians and other health care providers," Toby said. He also said that many requirements placed on doctors result from congressional mandates. Toby said, "HCFA is striving to strike the right balance between the convenience of patients, physicians and health providers, and the long-term financial stability of the Medicare program." ### EDITOR'S NOTE: HCFA, which also directs the Medicaid program, helps pay the medical bills of some 60 million Americans, at an estimated 1992 expenditure of $204 billion, the 12th largest governmental budget of any kind in the world.