Tardy Medicare reimbursements are hurting doctors in California, Nevada and Hawaii

[Lionel Mandrake]

Source: Los Angeles Times

Doctors across California and in two other Western states are owed millions of dollars in backlogged Medicare reimbursements, leading some physicians to turn away elderly patients and pushing others to the brink of bankruptcy.

In the most extreme cases, doctors have not been paid since February. Others are owed hundreds of thousands of dollars. Doctors who serve high numbers of Medicare patients say they are defaulting on rent, laying off staff and begging drug suppliers not to stop shipments. One cardiologist said she's even resorted to doing the office laundry to cut costs.

The holdup is twofold. By May, doctors were supposed to be using a new universal identification number assigned by the Centers for Medicare and Medicaid Services. Without the new number, which is like a Social Security number, doctors can't get reimbursed.

Then, as scores of doctors still waited for those numbers, in September the federal agency switched to a new claim processor for its 90,000 California providers. The move to Palmetto GBA in South Carolina, part of a national effort to reform Medicare contractors, compounded the billing issues and left even doctors who had their universal identification numbers waiting months for reimbursement.

Read more: http://www.latimes.com/news/local/la-me-medicare8-2008nov08,0,4948549.story

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This mess didn't just happen by accident. Whose idea was it to stop reimbursing doctors?

[yodoobo]

1. Just Bush trying to make single payer look bad

And any physician that turns away patients over their own internal billing issues through no fault of their patients should have their license revoked imo.

[Lionel Mandrake]

4. Maybe

I'd like to see some evidence, i.e., a smoking gun, that implicates W. or any of his cronies.

I think the doctors who aren't getting paid deserve some sympathy, too. Some face the choice of turning away patients or going bankrupt.

[liberalhistorian]

9. There are always jobs for doctors,

they may not be the fancy-pants jobs but they're there. They're just more interested in money. More and more of them are dropping their Medicare patients, even ones they've had for years, and even knowing that it's getting extremely difficult for such patients to even find another doctor who'll accept them (AARP magazine did a great expose on this). I'm sorry, but that's disgusting and uncalled for and they should not call themselves doctors if that's what they're gonna do.

And I'll save my sympathy for the patients needing treatment, or those with chronic conditions, but who can't afford it, who have to choose between medicine/medical care and food and/or rent, and who are either turned away altogether or damn near go bankrupt just to get medical treatment. That is unconscionable. We're not talking about gadgets and geegaws, we're talking about real human beings lives. Tens of thousands of people (I think it's a lot more, that's just a conservative estimate) die each year for lack of insurance or money for treatment. Some choose to forgo treatment altogether to save their families from bankruptcy. And I don't see doctors stepping up to do a damned thing about it, when they could have such an impact if they did.

And the medical field had better brace themselves because there is already a noticeable uptick in Americans forgoing medical care/treatment for financial reasons and it's only gonna get worse. The medical field is going to reap what they've sown.

[Lionel Mandrake]

16. Doctors make choices, and rightly so.

A doctor I had been going to for years dropped me because I am on medicare. It didn't bother me that much. I found another doctor, who accepts payment from medicare. And I live in California, where the problem is worse than in most other states.

Some doctors choose to be employees rather than entrepreneurs. When that happens, it is the employer who decides whether to accept payments from Medicare. This is not necessarily a boon for patients.

[liberalhistorian]

19. And what about the people who cannot find

another doctor and who need care? This is becoming a crisis in some states, soon to spread to others, and it's bullshit. Any doctor who puts profit above people should not be a doctor, period.

[harpboy_ak]

21. So docs should pay to practice?

So you think doctors should continue to treat Medicare patients at a loss? How long do you think a money-losing practice can stay open?

Don't blame the docs. Blame the congresscritters and pResident that refuse to fund Medicare at a high enough level that doctors don't lose money treating Medicare patients.

But this is all more grist for the mill of single payer health care.

[bmbmd]

41. They'll have to move to new homes.

Like those doctors in post 9 who lost their "fancy pants" jobs.

[Mojorabbit]

23. My husband is a family doc

and I can tell you if he did not get reimbursed for nine months we would be in huge financial trouble. We have an office mortgage, employees to pay, supplies to buy, utility bills etc. He sees plenty of people for free as it is and helps some of them pay for prescriptions they can't afford. The health care system is broken.

[CaliforniaPeggy]

2. What a dreadful mess!

I am appalled at it. And I'd sure like to find out who's behind it. An administrative nightmare of epic proportions...

:grr:

[Lionel Mandrake]

5. Yep.

A dreadful mess about sums it up.

I hope the LA Times keeps digging and finds out some more details.

[CaliforniaPeggy]

6. The LA Times is famous for pursuing this sort of story...

Once they get their teeth in it, they don't let go.

BTW...

K&R

:patriot:

[Lionel Mandrake]

8. My dear CP

Thank you for the K&R.

The LA Times has recently gone through another round of cost cutting and layoffs, but it's still a pretty good rag.

I agree that they will probably keep pursuing this story.

[Egnever]

3. By May, doctors were supposed to be using a new universal identification number

Sorry but sounds like these docs are doing it to themselves in a lot of cases.

No matter what the system clearly needs reform. Thank god we are going to get it.

[Lionel Mandrake]

7. Huh?

How are the doctors to blame?

Do you think any doctor who treats medicare patients hasn't tried like hell to obtain the new universal ID, and then to use it?

Read the story.

[liberalhistorian]

10. I would wager a lot of them haven't

even tried. They're too busy sending their patients who are behind to collections. And the doctors who are dropping Medicare patients knowing of the growing difficulty in finding another doctor who'll accept Medicare, and not caring about that, should have their license revoked.

[Egnever]

13. this line specificaly gives me pause

Palmetto officials said they receive about 4,500 calls per day -- that's down from the 45,000 calls on the first day when they had been expecting only 2,500. Through September, callers were met with a busy signal 90% of the time, Barlow said.

The fact that on day one they were flooded with 45,000 calls says to me that theres a lot of billers in there being lazy and not reading the instruction provided on accomodating the change over.

This company clearly was overwhelmed from the start though and should have been better prepared. I would still be willing to bet many doctors though have been uncooperative with anything other than demanding their cash.

[curse of greyface]

11. Universal Free Healthcare for all. NT

[MasonJar]

12. What a totally uncalled for disrespect for doctors who are not paid

for services. So physicians who have been serving the elderly and the poor should find other ways to make a living because the government refuses to pay them for services rendered. Now that is a great philosophy. The doctors that I know are dedicated citizens, who studied long and hard to serve humanity. They do not deserve these outrageous comments from DUers. The Bush government is wasting our money in Iraq and have tried every subterfuge available to shaft the average American to subsidize their lying and conniving rape of our country. Put the blame where it belongs. The Bushista has tried to screw lawyers and now more recently doctors. These losers in the WH are crooks; they are culpable.

[liberalhistorian]

15. Doctors are now dropping Medicare patients,

even those they've had for years, all the while knowing that they'll have great difficulty in finding another doctor who'll accept Medicare at a time when they often will need care more and more. That is unconscionable and inexcusable.

The vast majority of doctors nowadays won't even consider seeing you without insurance, period, and they then want their money NOW and are, like hospitals, very quick to send you to collections regardless of your circumstances. I'm sorry, but that's also unconscionable. Doctors were this way before Bush, frankly.

[Lionel Mandrake]

20. Doctors don't want to drop Medicare patients.

Some have no choice (other than bankruptcy).

Medicare reimbursement rates have been declining for years. Even when the bills are paid (as they used to be with some regularity), doctors typically lose money on medicare patients.

That many doctors are willing to keep their Medicare patients proves that they are not as greedy as you suppose.

[CountAllVotes]

31. my doctor takes Medicare

but excepts no more new patients. I've been having some very serious health problems and I had to call her back after seeing her the other day. She began screaming at me!

If I could find another doctor that would take Medicare I'd switch in a minute. However, they are difficult to find despite the fact that I have a supplemental policy that kicks in and pays the rest of the bill. The cost of this "wonderful" policy happens to be over $8,000.00 a year!

Some doctors never have enough bucks and they go into medicine for the money. When the bucks stop coming in they dump patients. Why shouldn't they? They can get twice the amount from other people with or without insurance being their fees aren't carved in stone as they are with Medicare.

[riancooks]

42. MEDICARE REIMBURSEMENT

I work everyday helping thousands of doctors get their monies
due to them from Medicare and other HMO's.  Doctors and their
staff work hard everyday to take care of people and they
should be paid on time.  We all understand that no doctors
office is perfect in their billing, but Medicare want even
response to many of the open claims.  

If your a doctor and need help send me an e-mail at
[e-mail].  

[defendandprotect]

14. Couldn't have anything to do with the "Bushing" of Medicare, could it?....

[Lionel Mandrake]

17. Yes, it could.

If so, we'll probably have to wait till January for any improvement.

[defendandprotect]

25. The lenghts these destroyers will go to is simply unbelievable --!!!

[jwirr]

18. *ss has found another way to stop a national health care plan by

convincing the doctors that they will not be paid if the government is involved. Damn him.

[Lionel Mandrake]

22. You may be right.

If McCain had been elected, he would become part of the problem.

I expect President-elect Obama to be part of the solution. And I hope he gives it some priority.

[kestrel91316]

24. Why just THESE states? Why not, say, TEXAS?

[defendandprotect]

26. Yeah ... what should we make of that--????

California, Nevada and Hawaii



Did these states attempt a STATE health care system, perhaps???

[Lionel Mandrake]

29. Maybe it's not just 3 states.

The story didn't say anything about other states. Maybe it's all states. Maybe just the blue ones. Who knows?

[liberalhistorian]

32. Believe me, it's happening in a lot of other states

as well, Ohio, my former home state, being one. Although I wouldn't be surprised if they were focused on really blue states or those that have attempted some form of comprehensive care.

[rocktivity]

27. Not to mention radiologists in New Jersey

ICE owes my boss more than $50 grand for x-rays taken of immigration detainees. Medicare owes him a fortune, too. But a government can't give out money it doesn't have, does it?

:headbang:
rocknation

[Lionel Mandrake]

28. The federal government can and should meet its obligations

Unlike individuals, corporations, cities, and states, the US Government can print money (legally).

[Tracer]

30. A shocking and appalling story:

I had a conversation with my oncologist last Thursday during a checkup.

We were chatting about economic hard times and he mentioned how some of his elderly patients were missing appointments and others were having a hard time paying for their medications.

Then he said that, in the past, he could treat them for less -- or for nothing -- but can't do that now because he could be sent to jail!

Just one medical coding mistake on a bill sent to Medicare is considered fraud and could cost him a $10,000 fine or jail time.

I couldn't believe my ears, but investigated on the web. Unfortunately it's true.

This is a miserable mess (along with reduced payments) and needs to be fixed ASAP. Otherwise, some really wonderful physicians (like mine) will continue to leave Medicare.

[Lionel Mandrake]

33. I don't understand.

Your doc could do what many others do, which is to accept whatever Medicare and the medigap policy (if any) pay and not try to collect anything more. The patient would pay nothing. The bill sent to Medicare would be correct. Where is the fraud?

[Tracer]

37. This was incomprehensible to me also, until I started educating myself:

The following is a few years old, but the problem remains the same.

http://www.aapsonline.org/press/getoutmc.htm

An AAPS survey of doctors reveals that Medicare rules and government threats to prosecute doctors make it more difficult for seniors to receive appropriate, necessary and timely medical care because doctors are afraid to treat tricky cases or take on new patients. Doctors spend less time practicing medicine and more complying with incomprehensible government regulations -- more than 110,000 pages.

"Spin the wheel in favor of your patient, go to jail or pay tens of thousands of dollars. The people President Clinton calls Medicare cheats are often doctors who give patients the best care. But if a government bureaucrat deems the treatment unnecessary or inappropriate, it's called fraud, and the doctor is pronounced a criminal," said Dr.Orient.

[Lionel Mandrake]

38. Thanks for the link,

but I still don't understand how it can be illegal for a doctor not to file a claim. How is it fraud to charge too little, or to charge nothing???

Also, I suspect that the Association of American Physicians and Surgeons, Inc. has a political agenda and that their deep concern for the welfare of patients should be taken with a grain of salt.

[not fooled]

34. Geez, do you think military CONtractors...

...are having the same problems getting reimbursed or funded??? Methinks NOT. Shows priorities of the * administration: bombs, not people. Disgusting bastards.:mad:

[customerserviceguy]

35. This has ripple effects all down the line

I work for a company that sells diagnostic equipment, and supplies for that equipment. Mostly, we deal with hospitals and larger medical centers that have good lines of credit, but some small practices get behind on payment terms, and are put on a cash-in-advance or a credit card paying basis only. Then they cannot get what they need to do treatments.

The government has always been slow to pay. If you're big enough, you can sell the receivables, and keep cash flow going, but if you run a small practice, slow pay is the death of your business. I don't blame the doctors, and hell yes, this is going to affect how they react to single-payer.

[Lionel Mandrake]

39. That's interesting.

I have a couple of questions:

1) if a big enough practice sells the receivables, who do they sell them to - a collection agency?

3) Wouldn't the practice lose a lot of money, and wouldn't the patients who haven't paid their bills be harassed by the collection agency?

[dbackjon]

36. Let me clear a few things up

I work as a controller for a medical practice in Arizona.

Medicare uses intermediaries throughout the country to process and pay claims. The intermediary that a doctor uses is based on the state you are in.

Medicare mandated the UPIN change this year. The change did not go smoothly ANYWHERE in the country. But, most intermediaries were able to clear this up in weeks or months. The intermediary covering CA, NV, and HI obviously had many other issues. My office waited over a month for $500,000. Fortunately, we had enough reserves to cover this.

My doctors treat a chronic illness, and have many medicare patients. They do ok, but also never refuse service to anyone in need. We work with patients to obtain Medicare or AHCCCS (Medicaid) if needed. We have treat illegals. But without Medicare money, there would be no money to pay staff, to buy drugs, etc.

[Lionel Mandrake]

40. Thanks for the clarification.

That does explain the variation from state to state.

Still, I wonder how the decision was made to choose an incompetent intermediary for CA, NV, and HI.

Is it mere incompetence, or is somebody getting rich off the deal?

Is this another example of republican foxes guarding the hen house?