[Federal Register Volume 66, Number 128 (Tuesday, July 3, 2001)]
[Notices]
[Pages 35260-35261]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-16744]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[HCFA-3073-N]


Medicare Program; Town Hall Meeting on Physician Query Forms

AGENCY: Centers for Medicare and Medicaid Services (CMS), HHS.

ACTION: Notice of meeting.

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SUMMARY: This notice announces a Town Hall meeting to discuss the use 
of coding summary forms (in this case, physician query forms) when the 
record is reviewed by a Peer Review Organization (PRO) to validate DRG 
coding. Physicians, providers, coding specialists, medical records 
staff, quality improvement professionals, and other interested parties 
are invited to this meeting to present their individual views on 
physician query forms. The opinions and alternatives provided during 
this meeting will assist us as we evaluate our policy on the use of 
physician query forms by PROs in verifying hospital coding. The meeting 
is open to the public, but attendance is limited to space available.

DATES: Meeting Date: The Town Hall meeting announced in this notice 
will be held on Friday, July 27, 2001, from 1:30 p.m. to 5:00 p.m. 
(Eastern Standard Time).

ADDRESSES: The Town Hall meeting will be held in the main auditorium of 
the Centers for Medicare and Medicaid Services building, 7500 Security 
Boulevard, Baltimore, MD 21244.
    Written Questions or Statements: Any interested party may send 
written comments by mail, fax, or electronically. We will accept 
written testimony, questions, or other statements, not to exceed (4) 
single-spaced, typed pages, before the meeting, and up until August 10, 
2001. Send written testimony, questions or other statements to: Sheila 
Blackstock, Quality Improvement Group, Office of Clinical Standards and 
Quality, Centers for Medicare and Medicaid Services, S3-021-01, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

FOR FURTHER INFORMATION CONTACT: Sheila Blackstock, (410) 786-3502 or 
Lana Reed, (410) 786-6875. You may also send inquiries about this 
meeting via email to [email protected].

SUPPLEMENTARY INFORMATION:

I. Background

    Section 1866(a)(1)(F) of the Social Security Act and 42 CFR Part 
476.71(a) require PROs to perform a number of review activities, 
including DRG validation review of inpatient hospital prospective 
payment system cases to make determinations as appropriate, in 
accordance with the terms of their contracts.
    Section 4130 of the PRO Manual directs PROs to:
     Review medical records to ensure that the record and the 
information on the claim submitted by the hospital agree;
     Base DRG validation upon accepted principles of coding 
practice; and
     Verify a hospital's coding in accordance with the coding 
principles reflected in the current edition of the ICD-9-CM coding 
manual.
    In January, 2001, we issued a policy memorandum to PROs directing 
them not to accept coding summary forms (physician query forms) as 
documentation in the medical record following DRG validation procedures 
specified in section 4130 of the PRO Manual. While this memorandum did 
not mandate an outright prohibition of the use of summary forms, it did 
prohibit PROs from using coding summary forms as a substitute for 
documentation in the medical record.
    The policy memorandum generated a high level of public interest. 
Subsequently, we recognized that there are varied interpretations of 
what constitutes proper supplemental usage of coding summary forms. As 
a result, in March 2001, we issued a second policy memorandum that 
suspended implementation of the January 2001 memorandum until October 
1, 2001. We now seek individual input from interested parties so that 
it may be considered as we re-evaluate this policy.

II. Meeting Format

    The initial portion of the meeting will be a presentation of our 
policy and our concerns with the use of physician query forms. The 
remainder of the meeting will be reserved for individual statements 
from interested parties.
    Time for participants to make a statement will be limited according 
to the number of registered participants. Therefore, individuals who 
wish to make a statement must contact the individuals identified in FOR 
FURTHER INFORMATION, above, as soon as possible to sign up to make a 
statement. Participants will be permitted to speak in the order in 
which they sign up. Comments from individuals not registered to speak 
will be heard after scheduled statements only if time permits.
    Written submissions will also be accepted.

III. Registration Instructions

    The Office of Clinical Standards and Quality is coordinating 
meeting registration. While there is no registration fee, individuals 
must register to attend. You may register by sending a fax to the 
attention of Lana Reed or Sheila Blackstock. The fax number is (410) 
786-8532. Please include your name, address, telephone number, and, if 
available, email address and fax number. You will receive a

[[Page 35261]]

registration confirmation with instructions for your arrival at the CMS 
complex. If seating capacity has been reached, you will be notified 
that the meeting has reached capacity.

    Authority: Sec. 1871 of the Social Security Act (42 U.S.C. 
1395hh).

(Catalog of Federal Domestic Assistance Program No. 93.773 
Medicare--Hospital Insurance Program; and Program No. 93.778, 
Medical Assistance Program)

    Dated: June 28, 2001.
Thomas A. Scully,
Administrator, Health Care Financing Administration.
[FR Doc. 01-16744 Filed 7-2-01; 8:45 am]
BILLING CODE 4120-01-P