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After nearly three years of work, the Physicians’ Regulatory Issues Team, an independent panel of doctors, has presented the Health Care Financing Administration (HCFA) with a list of 15 areas it says are ripe for regulatory reform and relief. Top topics on the hit list include:
• Advanced beneficiary notices. The panel says these are often confusing to both patients and physicians and may be in direct conflict with the Emergency Medical Treatment and Active Labor Act.
• Certificates of medical necessity. A survey by the American Medical Association found that 39% of physicians say these pose the single greatest Medicare headache.
• Coverage rules for follow-up visits for cancer patients. The panel claims that Medicare often refuses payment for these visits because carriers classify them as "routine screenings."
• Coverage of preoperative evaluations. These evaluations are also frequently denied for falling under "routine screenings."
• Laboratory services. These are subject to differing local carrier medical review and coverage policies.
"These aren’t the entire universe of potential issues a physician might have with Medicare regulations," notes Barbara Paul, MD, director of the physician panel. "But they are some of the most important day-to-day issues which, if properly addressed, can improve physicians’ ability to care for their patients."
The next step in this regulatory relief exercise is for the panel to create working groups with HCFA staffers to start reviewing these top five topics. "Our goal is to take on these five topics right now then add other issues as we can," says Paul.