It has become common practice for many medical associations to offer physicians courses on using the American Medical Association's Current Procedural Terminology (CPT), a list of descriptive terms and codes used to report medical services and procedures performed by physicians. A newly rleased report from the General Accounting Office (GAO) suggests that CME providers should pay careful attention to the content of such courses.
Between July 2000 and June 2001, the GAO sent investigators to coding CME courses sponsored by the Medical Society of the Districut of Columbia and the American Academy of Physician Assistants. In each case, the investigators found, according to the report, that the courses "provided certain advice that...if followed could result in violations of criminal and civil statutes."
Coding course consultants who advocate not reporting insurance overpayments, creating documentation to bill for services not actually performed, or limiting services to patients with low-paying health insurance coverage (such as Medicaid) are, in other words, encouraging physicians to break the law.
A copy of the report, entitled "Health Care: Consultants' Billing Advice May Lead to Improperly Paid Insurance Claims" GAO-01-818, released on June 27, is available at the GAO website. Click on "GAO Reports" and then "Today's Reports" and then "June 27, 2001."
