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American Academy of Emergency Medicine

AAEM Update: CMS directs carriers on unrestricted access to billings

In a culmination of intensive efforts by AAEM since 1996 regarding access to billings, CMS has provided a new directive to its carriers that is effective today March 12, 2004. The Medicare carriers may make payment to an entity only if the contractual arrangements between you and whomever is submitting bills on your behalf ensures that you have unrestricted access to what is billed in your name. This new policy is the end product of when AAEM was able to have language on "unrestricted access to billings" inserted in the conference committee report of the 2003 Medicare bill. Below you will find this historic language that is now part of the CMS Manual related to Medicare Claims Processing. Essentially, it is now codified that whomever submits Medicare claims on your behalf, be that a person (i.e. contract holder), group or entity (i.e. contract group), must ensure in your contract with them that you have "unrestricted access" to this information. It is also important to note that CMS still does not absolve the individual physician of responsibility for accurate claims (i.e. upcoding) but does clarify that the entity submitting the claim also is liable in these matters. This responsibility, as you know, is one of the key reasons AAEM sought this measure.

Emergency physicians should expect contractual changes that specifically delineate the methods of "unrestricted" access to billings submitted in their name. AAEM intends to follow this matter and wants to hear from you if attempts are made to "restrict" your real access to this information. We will be very interested in making sure there is full compliance with this policy. Please forward to us any concerns in this area as we move forth. Thanks greatly to the AAEM members who lent their support in this important battle over the last several years many of whom relayed personal experiences and samples of their contracts to CMS during their study of this issue.