[Congressional Record Volume 144, Number 53 (Monday, May 4, 1998)]
[Senate]
[Pages S4208-S4209]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 SENATE CONCURRENT RESOLUTION 93 EXPRESSING THE SENSE OF CONGRESS WITH 
             RESPECT TO MEDICARE DOCUMENTATION REQUIREMENTS

  Mr. TORRICELLI (for himself and Mr. Coverdell) submitted the 
following concurrent resolution; which was referred to the Committee on 
Finance:

                            S. Con. Res. 93

       Whereas adequate documentation is necessary to assure 
     quality and appropriateness of services;
       Whereas effective strategies to eliminate waste, fraud, and 
     abuse in the Medicare program should not result in excessive 
     documentation requirements being imposed on physicians that 
     will interfere with patient care;
       Whereas if the documentation in the medical record does not 
     meet program requirements, payments for such claims may be 
     denied and an investigation into potential fraud and abuse 
     may result;

[[Page S4209]]

       Whereas the administrative complexity of the documentation 
     requirements may increase the risk that physicians will make 
     inadvertent coding errors; and
       Whereas inadvertent errors or legitimate differences of 
     opinion on coding and documentation of physician services 
     under current law are not grounds for concluding that fraud 
     has occurred: Now, therefore, be it
       Resolved by the House of Representatives (the Senate 
     concurring), That it is the sense of the Congress that the 
     Health Care Financing Administration should--
       (1) further postpone its plans to implement the 
     documentation guidelines for evaluation and management 
     services, as currently constituted;
       (2) continue consultation with organizations representing 
     physicians on how to reduce the complexity of any such 
     guidelines prior to their use by Medicare or its agents in 
     review of claims submitted to the program;
       (3) conduct a pilot study of any such documentation 
     requirements prior to use in audits and other review 
     activities; and
       (4) assure that any such documentation guidelines, if 
     applied by Medicare or its agents in review activities, 
     contribute to quality care and do not detract from good 
     patient care by requiring physicians to spend undue time 
     documenting their services--at the expense of spending less 
     time with patients--or lead to sanctions being imposed for 
     unintentional coding and documentation errors.

  Mr. TORRICELLI. Mr. President, I rise today on behalf of myself and 
my colleague from Georgia, Senator Coverdell, to submit a concurrent 
resolution expressing the sense of Congress with respect to 
documentation requirements for physicians who submit claims to Medicare 
for office visits and other evaluation and management services.
  In May of last year, the Health Care Financing Administration (HCFA) 
released revised Medicare documentation guidelines for evaluation and 
management (E/M) services. The guidelines were intended to provide 
physicians and claims reviewers advice about preparing and reviewing 
documentation for E/M services. They were also expected to improve the 
quality of medical records and continuity of patient care.
  It is clear now, nearly eight months after the guidelines were 
implemented, that the guidelines' intent has not been fulfilled. Rather 
than improving the quality of patient care, the new E/M guidelines have 
caused patient care to suffer.
  I have received hundreds of letters from physicians in my state of 
New Jersey telling me that they spend so much time trying to figure out 
how to bill Medicare under the new guidelines that they have little 
time left for their patients. There are 42 choices a physician must 
consider before selecting the proper E/M code for a given service. 
These kind of highly complicated and excessive billing guidelines force 
physicians to spend less time with their patients and more time on 
their charts. The result is a diversion of the physicians' attention 
away from patient care and medical decision-making. Even the American 
Medical Association (AMA), who helped draft the guidelines, warns that 
they may impose an undue burden on physicians that may detract from 
patient care. These concerns have prompted the AMA to commit to make 
changes in the guidelines that address concerns about their complexity.
  The resolution I rise to submit today expresses the sense of Congress 
that HCFA should postpone its plan to implement the documentation 
guidelines and continue consultation with physicians organizations on 
how to reduce the complexity of E/M guidelines. The resolution also 
expresses the sense of Congress that HCFA should conduct a pilot study 
of any documentation requirements prior to their implementation to 
assure that they contribute to, rather than detract from, quality 
patient care.
  It is well settled that adequate documentation is necessary to assure 
quality and appropriateness of Medicare services. It is also needed to 
prevent waste, fraud and abuse. However, we in Congress have a 
responsibility to ensure that strategies to address these issues not 
result in burdensome requirements that interfere with patient care.

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