American College of Physicians: Internal Medicine — Doctors for Adults ®

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How the College develops its public policy agenda

From the April ACP Observer, copyright 2003 by the American College of Physicians.

  • College says smallpox vaccination plan should target limited group
  • ACP pushes Medicare to cover screenings before colonoscopy
  • Bill would boost Medicare pay for doctors in underserved areas
  • ACP urges insurer to follow CPT guidelines

College says smallpox vaccination plan should target limited group

In a new position paper, ACP voiced support for smallpox vaccinations for a limited number of first responders as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP). While acute care hospitals with emergency rooms face some risk, the paper said, entire hospital staffs do not need to be vaccinated.

The ACP paper also expressed concern that a large percentage of the population is vulnerable to complications from the vaccine due to HIV/AIDS, cancer and certain skin conditions. The paper recommended that the government examine data from the initial stages of its vaccination effort before expanding the program.

Because most experts consider the risk of a smallpox outbreak uncertain, the College recommended that any smallpox vaccination program remain voluntary. The ACP paper also called for strict guidelines to make sure that people are fully informed of—and screened for—known risk factors.

Finally, ACP urged extreme caution in expanding the smallpox vaccination program beyond ACIP's recommendation to a much larger population of first responders.

The paper is available online.

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ACP pushes Medicare to cover screenings before colonoscopy

The College urged Medicare to reimburse physicians who provide an evaluation and management service to help prepare patients for a screening colonoscopy.

In a Feb. 21 letter to Thomas Scully, administrator of the Centers for Medicare and Medicaid Services (CMS), ACP urged the CMS to pay physicians to screen patients before colonoscopy, just as it pays for pre-operative screenings.

The College noted that colonoscopies require beneficiaries to be instructed on preparatory steps, involve conscious sedation and can result in serious complications such as perforations. As a result, the letter said, even some healthy patients can benefit from an evaluation before the procedure.

The letter also suggested several existing codes that physicians could use to indicate they have evaluated both low- and high-risk patients.

The College's letter is online.

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Bill would boost Medicare pay for doctors in underserved areas

ACP is supporting legislation to streamline the incentive program Medicare uses to attract physicians to underserved areas.

The Medicare Incentive Payment Program pays physicians who serve in certain underserved areas a 10% bonus. The Medicare Incentive Payment Program Improvement Act of 2003 (S. 379) would continue to pay physicians in these areas a 10% bonus for the services they provide, but it would make it much easier for physicians to actually get the bonus.

The College supported the bill in a Feb. 13 letter.

While the program was first created in 1987, few physicians are aware of it. Others who know about the program say there are too many barriers to easily get the bonus.

Providers must first determine if their services qualify under the program. If they do qualify, they must amend their Medicare claims with a special modifier and undergo a stringent audit process.

The Senate bill would require Medicare to educate physicians about the program and remove barriers to participation. In addition, physicians would no longer have to use a modifier to identify eligible services.

Under the proposed legislation, carriers—not doctors—would determine physicians' eligibility for the program based on the physician's location. This would eliminate the need for the stringent audit process that deterred some providers from claiming the bonus.

ACP's letter is online.

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ACP urges insurer to follow CPT guidelines

The College joined six other organizations in urging the Health Care Service Corporation (HCSC) to follow Current Procedural Terminology (CPT) guidelines.

In a Feb. 28 letter, the organizations charged that HCSC's health plans regularly downcode physician services, ignore appropriately bundled codes and fail to recognize CPT modifiers. As a result of these errors, HCSC's health plans have underpaid physicians.

Physicians have complained, for example, that the health plans regularly ignore modifier -25, which allows physicians to indicate that they performed a significant, separately identifiable evaluation and management service on the same date as another procedure or service. The letter said that HCSC health plans have denied CPT code 69210 (removal of impacted cerumen, separate procedure), stating that it is bundled into the payment for an evaluation and management service.

ACP and the other groups have received numerous complaints about HCSC's misapplication of CPT codes, guidelines and conventions. The letter is online.

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