The ACP Advocate Blog
by Bob Doherty
Thursday, June 30, 2011
A form for every purpose under heaven
For physicians, and especially those in primary care, it seems like there is a form for every purpose imaginable—often for purposes that are hard to imagine.
An ACP member in Rhode Island recently gave this example:
“I was just asked by my Medicare Advantage plan to sign a form for [a well-known pharmacy benefit manager]. This form is to be faxed to them in order for them to send me a prior authorization form for a med. So in other words, I had to complete a form in order to get another form. This is nuts!”
Or how about this, from another ACP member in a private internal medicine practice:
“The documentation that is getting to me, is that documentation that the ‘durable medical equipment people want including repetitive- recurrent documentation, whenever we see a patient to document "continued need". The list of things we have to document, sign, approve or prior authorize, I believe is what makes most physicians think they chose the wrong field. A PBM letter to me about my prescribing practices today nearly did me in! Luckily I just shredded it. If I am kicked out of this business, I am so close to retirement it would be a blessing!”
“In 2011 we now have to complete the ‘Home Health Face to Face Encounter form, a one and a 1/2 pager that is required for every patient starting home health care, in addition to the plan of care forms. IMHO, this is getting ridiculous. Any one of these is really no big deal, but the collective volume of these forms is stifling and is taking away from time with my patients and my family. If I happen to have a med student with me, they can't help but notice the significance of the volume of paperwork in my ‘paperless office, that delays me entering the exam room.”
Wouldn’t it be great if there was a law to require insurance companies to reduce paperwork requirements on physicians and patients?
There is. A law recently passed by Congress requires the following:
--By January 1, 2012, the federal government must seek input as to whether the process by which physicians and other providers enroll to participate in a health plan can be made standard and electronic, including whether a uniform application form is viable.
--By October 1, 2012, the federal government must establish a system that provides a unique identification number for each health plan. Ensuring that each health plan has only a single identification number should improve the ability of physician practices to manage their administration interactions with health plans.
--By January 1, 2013, insurance companies will be require to abide by a standard set of rules to facilitate electronic transactions, including use of machine readable identification cards, to enable physician practices to verify patient health insurance coverage eligibility and obtain the status of claims submitted to bill for services. Physicians will be able to determine the insurance product that covers the patient, whether a specific service is covered, any patient financial responsibility, prior to or at the time of the patient encounter; whether the insurer received the claim submitted and the status of an accepted claim in the processing cycle, and be able to access information on how a determination is made whether to pay a claim and how to appeal adverse determinations.
--By January 1, 2014, insurers will be required to comply with standards on electronic funds transfers (EFTs) and claims remittance/payment. They must allow for automated reconciliation of the electronic payment the physician receives and the corresponding remittance advice that the health plan provides.
--By January 1, 2016, the federal government will implement a standard set of rules for the administrative transactions: health claims; referral; certification; and authorization. Standardization related to these transactions is intended to decrease the burden on physicians and patient that comes with required use of different forms for different payers. Also, insurers will have to comply with a standard and associated set of operating rules that pertain to health claim attachments.
The best part is all insurers will be required to comply—and will be fined if they don’t.
Do you know what this new law is called? The Affordable Care Act (ACA)--yes, the same health reform law derided by some as putting more “bureaucracy” into the doctor-patient relationship. (To learn more about the ACA’s administrative simplification requirements, go to ACP's Practical Guide to Health System Reform, and under the table of contents organized by topic and year, click on the heading Simplifying Administrative Requirements the Health Care System Imposes on Physicians.)
The ACA may not entirely solve the paperwork problem, and it undoubtedly will create some of its own paperwork, some of which will have to be challenged. But it will put in motion the most comprehensive and systematic federal effort ever to streamline, standardize, automate, and reduce paperwork associated with health insurance transactions.
That is, to reduce the kind of paperwork that causes internists to pull out their hair and scream “This is Nuts!”
Today’s questions: What do you think about the federal government requiring insurance companies to streamline, standardize, automate, and reduce paperwork associated with health insurance transactions? And were you aware that the ACA requires this?
Update: CMS today issued an interim proposed rule to make it easier for physicians to check patient eligibility and status of claims.
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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