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The Centers for Medicare and Medicaid Services (CMS) today announced a new, streamlined enrollment form that will make it easier for qualified physicians and other health-care providers to become eligible for Medicare reimbursement for the care and services that they provide on behalf of Medicare beneficiaries. Medicare will begin using the new user-friendly forms effective Nov. 1. The forms reflect extensive input from physicians and allow doctors and other providers to fill out only the portions relevant to their practices.

The new form is part of CMS’ broader effort to be more responsive to the needs of physicians and other health-care providers. CMS Administrator Thomas A. Scully launched the agency’s “Open Door Initiative” in July to reduce unnecessary administrative burdens and to fulfill Health and Human Services Secretary Tommy G. Thompson’s commitment to create a culture of responsiveness at CMS, which administers the Medicare program.

“This simpler form is the most recent result of our agency-wide efforts to reduce Medicare hassles and let physicians and physician groups focus on patient care, not paperwork,” Scully said. “Our goal is to create a simpler, more effective Medicare that makes it easier for our 40 million beneficiaries to get the quality care and services they deserve.

In developing the new form, CMS began by analyzing enrollment data to determine how long it took for an enrollment application to be processed, as well as any reasons for processing delays. The agency found that the previous form was confusing, causing applicants to omit information and resulting in delays in processing. In addition to simplifying the enrollment form, CMS has tightened up its internal deadlines for processing enrollment forms, requiring 90 percent of applications to be processed within 60 days of receipt and 99 percent within 120 days.

“Enrollment is the ‘handshake’ for the business relationship between a physician, supplier or provider and Medicare,” said Timothy Hill, director of the Program Integrity Group. “The new forms and expedited processing will make it easier for physicians to begin caring for Medicare beneficiaries, while allowing CMS to make sure that only qualified physicians are eligible to receive taxpayer dollars.”

“The activities of the Open Door Initiative are an example of CMS’ increased focus on improving relationships with the physicians and other providers who care for Medicare beneficiaries,” said Ruben King-Shaw Jr., CMS’ deputy administrator and chief operating officer, who chairs the Open Door Initiative efforts for physicians. “In a short period of time, CMS staff, working closely with our physician partners, have successfully chipped away at a laundry list of physician complaints.”

Recent policy changes include:

• Easier access to beneficiary eligibility information. Physicians have had difficulty determining if a beneficiary is enrolled in the Medicare+Choice or fee-for-service programs, making it hard to know what rules apply to referrals for diagnostic tests, hospitalization and other services. A recently released program instruction authorizes contractors to communicate eligibility information to physicians and providers by telephone without violating patient confidentiality.
  
  
• Improved Program Integrity operations. CMS is responsible for making sure that Medicare pays only for those services authorized by the Medicare law. The agency is now implementing a new system for monitoring the propriety of payments-the Comprehensive Error Rate Testing Program. “We believe the new program will provide CMS with more useful information, with less hassle for physicians and their office staff,” says Hill.
  
  
• Reduced frequency of re-credentialing for physicians in Medicare+Choice Plans, other M+C improvements for physicians. CMS has extended from two years to three the time period for plans to recredential their physicians to be consistent with the national accrediting community. In addition, CMS has clarified that not all physicians in a M+C network are required to have hospital admitting privileges, so long as the plan has an adequate panel of physicians with such privileges. Additionally, physicians in a M+C network with provisional hospital privileges may care for patients while awaiting full hospital privileges.
  
  
• Simpler Advance Beneficiary Notices (ABN) and clearer guidance about their use. The agency recently posted on its Web site new simplified ABN forms that physicians may download and use. There is an ABN for general use, an ABN especially designed for use with laboratory tests, and, at the request of physician groups, an optional ABN that physicians can use to explain to patients what services are never covered by Medicare. The agency has also posted a set of Frequently Asked Questions, addressing such issues as the proper use of ABNs in emergency rooms, the laboratory's v. the physician's responsibility to execute an ABN, and patient questions about ABNs. These materials can be found at: Medicare Learning Network
  
  
• Clarification of policies re: physician ordering of diagnostic tests. The agency has clarified Medicare policies regarding the ordering of diagnostic tests, including diagnostic radiology and clinical laboratory procedures, which play a central role in treating Medicare beneficiaries. Specifically, effective Sept. 27, 2001, Medicare permits radiologists to perform additional diagnostic tests, including diagnostic mammograms, when: (1) there is an abnormal result on the ordered test; (2) the beneficiary’s treating physician or practitioner cannot be reached, and (3) delay would have an adverse affect on the beneficiary’s care. For surgical or cytopathology specimens, Medicare now permits a pathologist to perform additional tests, such as special stains, needed to make a complete and accurate diagnosis, without separate authorization from the treating physician. For both radiology and pathology procedures, the medical necessity of the additional tests must be documented in the patient’s record.
  
  
• Expansion of mammogram payment. CMS has instructed contractors to allow payment for screening and diagnostic mammograms performed on the same day. Previously, when both tests were performed on the same day, only the diagnostic procedure was eligible for Medicare reimbursement.
  
  
• Clarified instructions for reporting results of diagnostic tests, Physicians who follow ICD-9-CM coding instructions sometimes are denied payment for medically necessary services. New instructions, released on Sept. 26, 2001, provide a stepwise approach and clarifications to coding for these services, helping to assure that medically appropriate services are indeed paid for by the program.
  
  
• Information for patients that is useful for physicians. The Medicare & You beneficiary handbook is increasingly useful to clinicians as well as the 40 million Medicare beneficiaries who routinely receive this annual mailing. This year the agency developed a special Physician’s Edition of Medicare & You 2002, highlighting key information for physician practices in a physician supplement that contains informative regulatory and policy updates. This is currently in the mail to 600,000 participating physicians around the country.
  
  
• Enhanced role of practicing physicians in policy development. Physicians within and outside the agency have played important roles in CMS’ efforts to identify and eliminate unnecessary regulatory burden. CMS now counts 45 physicians on staff in central and regional offices, a tripling of the number of physicians at the agency in the past four years, and the administrator’s goal is to again double that number in the next year.
  
  
• Participating in Preceptorship Programs across America. CMS staff are also continuing to participate in preceptorship programs organized by state and county medical societies. The most recent event was hosted by the Philadelphia County Medical Society. The preceptorship programs give policy makers in CMS the opportunity to “shadow” physicians in a variety of work places, to gain a greater awareness of the impact of Medicare policies on patient care.