American Hospital Association and Medicare bill

¶ … American Hospital Association (AHA) might be interested in the pending legislation:

Although all three positions of the proposed bill would be of concern, two of the three would cause serious ramifications for the AHA and its members. The first would be the 5% annual reduction. This cut equates to a very serious amount of income for the industry especially if the cut was scheduled for across the board reductions. Hospitals and nursing homes are already working at bare bones and more cuts would cause serious financial dilemmas if implemented. If the cuts are unique to certain aspects of the Medicare billing system, the AHA would need clear details of where the proposed cuts would actually be coming from.

The second of the three major concerns would be the simplification for assessing penalties to providers accused of abusing the Medicare payment system. It is the AHA's stance that providers should still be first considered innocent until proven guilty. But these proposed regulation changes do not take into consideration that it has been clearly demonstrated that often what has been construed as Medicare fraud can actually be unintentional mistakes due to the difficult Medicare documentation process.

2. Make a statement AHA would make regarding this issue:

We are pleased that the Medicare legislation process is doing its best to try to rectify some of the perceived problems in the billing and related abuse litigation processes, however, we at the AHA feel that a 5% cut is excessive less stringent abuse prosecution procedures could lead to and possibly even promote many unsubstantiated and even frivolous law suits against the providers of the healthcare industry.

The AHA on many occasions has demonstrated that there are simply too many hands in the Medicare billing process pot. Examples include: Local, State and Fiscal intermediaries, private and semi-private insurance companies and other companies that process claims, private corporations and industry representatives that do their own claims, Unions and the obviously the Medicare offices themselves. Couple that with a billing system that has many bottleneck paperwork points, completely confusing regulations with many contradictory instructions and other inert problems and it is a wonder more errors that could be construed as abuse do not occur. It is the AHA's position that rather than spending money on prosecuting unsubstantiated abuse claims or reducing provider funding, it would be better for this proposed legislation to address the existing Health Care Financing Administration (HCFA) so as to create a viable alternative to the existing convoluted billing regulations. There are many potential savings in greater amounts than 5% that could be recouped in fixing the existing billing system as opposed to a 5% cut for providers.

3. Determine the most appropriate government entity to which this association should address its concerns regarding the pending legislation

There are three offices these concerns should be forwarded to for the AHA. The first is the Office of the Inspector General (OIG) who is responsible for the annual Medicare billing audits. The second is the Health Care Financing Administration (HCFA) who is responsible for overseeing the convoluted billing regulations in place today. The third would be the entity that is proposing the bill, for example a specific congressman, senator or other governmental office with the authority to proceed with the bill.

4. Prepare a memo to the appropriate government entity selected that: The focus will be to the bill writer:

Memorandum

Dear Sir (office writing the bill)

CC:

HCFA, OIG

AHA

10/15/2004

Re:

Recent Medicare Bill Proposal

The AHA would like to express its serious concern regarding the pending Medicare Bill legislation that your office has proposed. Our constituency has voiced that they are fully against the proposed 5% cut in Medicare funding for providers as well as the proposed statutory changes affecting the existing Medicare billing abuse litigation process.

We here at the AHA feel it is our responsibility as representatives of the American Hospital Association to say that there are alternative options available. Rather than implementing you proposed legislation, it is the AHA's position that the money that would be spent on prosecuting unsubstantiated abuse claims and reduced provider funding would be better spent addressing the existing Health Care Financing Administration (HCFA) convoluted billing process. There are many potential savings that amount to more than 5% and could be recouped by simply fixing the existing billing process.