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


Policy Briefs

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

  • CMS offers coding 'edits' on the Web free of charge
  • Medicare should use better data to calculate drug costs
  • ACP supports bill to help doctors refinance student loans

CMS offers coding 'edits' on the Web free of charge

As promised earlier this summer, the Centers for Medicare and Medicaid Services (CMS) has put its correct coding initiative "edits" online free of charge. The change was made as a direct result of ACP's advocacy efforts with the CMS.

CCI edits are pairs of codes that are not separately payable, except under special circumstances. Medicare uses these edits to decide whether to pay claims in full, pay a partial claim, completely deny claims or recode the submitted procedures. The CCI currently contains more than 100,000 coding edits.

Physicians have been frustrated because they haven't had free access to CCI information on how to code "properly." Until recently, physicians had to purchase the edits and quarterly updates for an annual subscription of $300 for a print version or $260 for an electronic version.

The edits are now online.

For more information on the correct coding initiative, go online.


Medicare should use better data to calculate drug costs

The College is asking Medicare to change the way it calculates its drug costs to reimburse physicians more accurately.

In a Sept. 15 letter to Thomas Scully, administrator of the Centers for Medicare and Medicaid Services (CMS), the College said that inaccurate information is causing Medicare to underestimate the wholesale price of some of the drugs it covers. The program uses that price in determining how much to reimburse physicians for drugs they administer.

The College noted that the contractor that calculates average wholesale drug prices for Medicare includes prices charged by "repackers" and "repackagers." Because these organizations purchase large amounts of drugs from manufacturers and sell them at a discount, including their prices drives down average costs—and hurts physician reimbursement.

ACP noted that while the CMS has discontinued factoring repacker/repackaging prices into its pricing structure for pneumococcal vaccine payment, Medicare needs to stop factoring these prices into its reimbursements for all drugs.

The College also said that Medicare factors in the costs of drugs that are no longer on the market. Using out-of-date drug data, ACP said, can inappropriately lower the prices of drugs available from multiple manufacturers.

The letter is online.


ACP supports bill to help doctors refinance student loans

ACP is supporting new legislation that would allow physicians to refinance their medical student loans to lower their loan payments.

In a Sept. 10 letter to the chairman of the Subcommittee on 21st Century Competitiveness, ACP said that the refinancing provisions of the College Loan Assistance Act of 2003 (H.R. 2505) would help American medicine recruit medical students to specialties like internal medicine by helping reduce medical debt. Experts say debt and income issues are key to revitalizing internal medicine.

The letter pointed out that the staggering level of student debt for many medical students—an average of $103,000 in 2002—discourages young physicians from entering specialties like internal medicine that pay less than other, more lucrative areas of medicine.

In the letter, the College disputed several commonly-used arguments against letting medical students refinance their loans. Critics argue, for example, that physicians should not be able to refinance loans the same way homeowners can refinance a mortgage because there is no tangible asset to repossess if the borrower defaults.

As ACP pointed out, however, that argument does not take into account the stiff penalties physicians face for not repaying student loans. Defaulting on a consolidation loan, for example, can result in loss of tax refunds, withheld wages and loss of medical licensure.

The letter is online.


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