CMS attempts to lighten Medicare burdens. (ICD-9 Coding, Eligibility Determinations).

WASHINGTON -- Medicare wants to know when doctors are frustrated.

Really.

"We care if the [Medicare] program is well administered and we want to know when it's not," said Dr. Barbara Paul, head of the Physician Regulatory Issues Team at the Centers for Medicare and Medicaid Services (CMS). The Physician Regulatory Issues Team (PRIT) was created 3 years ago in response to physicians' complaints that there was no way to keep up with the hundreds of pages of Medicare regulations that they faced.

"There is a burden placed on the health care community by these requirements, and Medicare does have a significant role to play in helping to reduce this burden," Dr. Paul said in an interview. One step being taken to lighten the load is the PRIT's Physician Issues Project to examine the "top 25" Medicare concerns of physicians. "One change we made has to do with instructions regarding ICD-9 coding," she said. "We were hearing about many doctors complaining that [even] when they followed official, published ICD-9 coding instructions for a service that we all agreed should be paid for by Medicare, they were getting denials." For example, pathologists looking at "suspicious" skin biopsy specimens that turned out to be normal would find their payment being denied, even though the biopsy had been ordered appropriately.

The problem occurred because ICD-9 is its own coding scheme with its own set of rules, and sometimes ICD-9's rules were in conflict with Medicare's reimbursement regulations. CMS changed its regulations so that physicians can still meet ICD-9 requirements, but can also make sure there's enough information on the bill to make clear that the service was necessary and should be paid for.

Another problem area was eligibility determinations. "Physicians simply needed to know whether the patient was in Medicare + Choice or in fee-for-service Medicare," she said. "Knowing this information is important if you're trying to order ultrasound or other tests. Patients don't always know what plan they're in, nor is their Medicare card always accurate." But when doctors contacted their Medicare carriers to get the information, they were told they couldn't have it because it was confidential. CMS has since issued instructions to carriers stating that they could give that information out to physicians.

To get a better feel for physicians' day-to-day hassles, PRIT has also started a preceptor program in which CMS staff members are sent to visit a practicing physician's office for a few days to get a feel for what the hassle factors are. "Staff can experience firsthand a day in the life of a physician," Dr. Paul said. "Watching staff members come back from these, we find that it is a real eye-opener for them. It's a wonderful learning experience."