family practice issues and general life events

This is an email that I would send to the Center for Medicare and Medicaid Services, but since they don’t have an email address for themselves, unless I want to report fraud on either myself or another, well I will have to make do.


Dear CMS-

I would say that you don’t know who I am, but you have used my picture for the last year advertising your EHR Incentive program as the first clinic to receive the Incentive Bonus from Medicaid.  So you must at least have an idea of who I am.  That being said, you probably don’t care, but at least you know that I have tried to play by your rules in order to win that honor.

Couple that with the calls a couple times a month from the Office of the Inspector General looking for the physician whom we  agreed to become custodian of record for, well you have talked to at the very least my office staff.  And we have given you all of the information we have.  OR have at least indicated just let us know what you want, we believe that she left the country, given you the email addresses we have, but we don’t have what you are looking for.  Well other than the patients version of what she did.  But otherwise you have not had many dealings with me.

I have a practice of 45% Medicaid and 25% Medicare.  So all together about 70% of my practice is receiving “insurance” from your office.  Over the past year, we have done all of your recommendations for 5010 conversion, and per you and our systems passed them all.  We have performed the required updates, installed the needed hardware, software, implemented the required training, all that you have indicated as necessary.  So based on those, we were ready for the conversion January 1, despite the delay to March 1, 2012.  However, you decided to implement the conversion on December 19, 2011 and installed a firewall.  This firewall blocking all new claims from going through.  We didn’t notice it right away, due to a 2 week to 45 days delay from date filed to date paid.  So we didn’t notice.  Add to that the notification that claims would be delayed about 2 weeks, well it took a little while.  25% is a large chunk of income, but it would have been ok, for a short period of time.

On December 28, the firewall went up for Medicaid.  Again there was a slight delay in noticing, since the turn around is two weeks, plus we were told that there would be a two week delay.  However, this was somewhat more painful.  Added to that the insurance companies have all installed required firewalls, however, after three weeks, we are finally through and getting paid.  So we are receiving payment for 30% of the work that we do.  That does not even cover my staff or overhead.

My understanding is that I am not alone in this problem.  It is neither EHR vendor specific nor clearinghouse specific.  The only constant is that they are plans paid for under your umbrella, Medicare, Medicaid and Tricare.  And one message received was that I was fortunate, at least my problems only started in mid-December, not early November like some physicians.  Whatever.  I have not taken a paycheck since the middle of December.  That is no paycheck for either my husband (also a physician) and me.  Still had to make payroll for the staff of eight that I employ.  Well currently seven, due to a recent death.  But even she received a paycheck this last pay period.  So I have had enough to pay 8 people, well up until this week.  This week, I had to pay some staff out of personal accounts.  So now, not only am I working for free, I am paying for the privilege to deal with government regulations and bureaucracy.

Oh and did I mention that I experienced the privilege of an audit by Oklahoma Medicaid during this time, which other than a few minor problems, I passed.  One of those being something that I have no control over, being specialists not sending their consult notes to go with the referral that they got paid for, but somehow that is my deficiency, DESPITE CALLING AND ASKING FOR A NOTE!!

So anyway back to the point of this message that you will neither read, nor receive, but maybe someone out there will hear me.  I paid for the pleasure of working last week, PERSONALLY!!  And I wonder why I constantly have a headache, and the gnawing of an ulcer in my belly.  I own my clinic, and am personally responsible for the debt to go into business.  I don’t have a big corporation that can afford a short period of time to cover not being paid.  My clinic sees 68 patients on average a day, so I should not have a negative balance sheet, but I do because for 70% of them, I have not seen a dime since December 28, maybe a few more due to the small amount of TriCare that I also see.

I know that I am not the only one who is experiencing this, since this week we were 2017 in line when calling to see where the problem was.  (We were 1700 last week, and that ended with 7 and a half hours on hold, only to be told to check online for solutions, WHICH WERE NOT THERE!!!)

I scraped enough for payroll this week.  In two weeks, I may be able to do it again, even without payment.  But after that I will be done, I will have no choice but to close my doors.  I understand the theory that you should love what you are doing so much that you would do it for free, but I did that the first 18 months in practice, and 6 months in 2010, and an occasional pay period here and there.  But I cannot afford to do that for much longer.  And I definitely cannot afford to do it and pay to do so.  Currently I have $120,000 in Medicaid Accounts Receivable since December 28, and another $60,000 in Medicare. (that is not what I will receive, only what I am billing)  And if by some miracle that were to come through tomorrow, I now have back bills and creditors who would also like to be paid, so even if you were to fix it tomorrow, I will be working for free until May or June.  So my husband will have to spend more time away from his boys, and work more shifts in the ER so we will survive.

I know to some, this is what I deserve being a greedy doctor, though I have yet to make over $100,000 personally since graduating residency.  (My declared income is higher only because of my husband working in the Emergency Room)  I have bills to pay, and cannot afford to continue floating the payroll for the clinic.  So I am asking CMS to look at their firewall, and attempt to fix it, or the looming doctor crises will come in about 2 or 3 months instead of the 3-5 years that is currently anticipated.


P.S. If this is your plan to save Medicare, it is a really crappy thing to do.  You should look closer at where your biggest incidences of fraud occur, and not cause those who are playing by the rules to become financially ruined.


Comments on: "Dear Center for Medicare and Medicaid Services" (7)

  1. Good luck with the above. My dad says the government is like a huge funnel: They pour a lot of ‘stuff’ in at the top, it’s concentrated and comes out with full force at the recipient.

    But if you try to send something back up the funnel, it sprays all over diluted and never gets to the intended target.



    • That is probably the best metaphor ever. I am not sure that I actually expect any help from them at all. But I am currently running out of options, and thought maybe just maybe this could help. At the very least I am attempting to give voice to the lone family practitioner who is not a part of a big group with a guaranteed salary. It is probably the beginning of the end for us

  2. I wish you all the luck with this. I handle physicians billing out of my house (with my 2 boys also) and had to explain to many of them why income is low. I must say the 5010 conversation has kept me up at night (along with the baby) hoping everything goes smoothly. There has been many cuts across the board, not only with government but also commercial policies. Yes, the fee schedule may look high to many patients when they receive their EOBs, but take out taxes, payroll, rent & all other overhead and then look at the bottom line. We cannot continue in this direction. And then there will be the ICD-10 conversion, let’s see how that goes.

    • Thank you for your kind words. I am hoping for a little luck myself. I am trying to figure out the best way to go now, and I am probably going to see about getting my patients involved. It cannot hurt and maybe if I am lucky it will help. Unfortunately, physicians have for too long allowed themselves to be seen as greedy and not actually told their sides of the story. I cannot afford to pay my employees out of my own pocket, and have probably only one more pay period that I could do it, before the decision to close will be made. I wish you luck as well. And we will continue to hope for a solution where we get paid for work that we have done. I have written both my senators and my representative in the House. I am not hoping for much, but maybe one will listen. As one of my Senators was a physician before politics, maybe this will resonate with him and maybe he can help. If it doesn’t work out though, at least I tried for both my staff and patients.

  3. Melissa,

    Thank You for taking time to write part of your story, at least a glimpse of your current situation. I feel for you. Many of my providers/clients are experiencing HORRIFIC issues with 5010. The impact has been phenomenal…these changes are either a hype for nothing or a big fiasco. Unfortunately, this one has been the latter. I wish I lived in your state, or new your software vendor/clearinghouse to try to help you…however, I am having a hard time myself just keeping my nose above water working from sunup till the wee hours of the morning. The last 8-10 weeks have been beyond words of insanity. I pray the solutions arise sooner than later, we are not in a position as a country to loose more doctors. We need the ones we have!

    Stay in touch!


    • Supposedly according to the Vendor and the Clearinghouse the problem is now fixed. We are trying again to see. We were actually in the process of looking for an outside biller, and had committed to one about 2 weeks before we realized the problem. They have actually been helpful in trying to help us fix the problem, and this week we were able to get a check from Medicaid. (It should have been more, but the Medicaid site crashed on last Friday and was down until Wednesday. When it rains it pours, I guess)
      I would guess that you have been up quite a bit. And worried as we have been. I will still have to go out and take a loan from the bank, because the money that came in this week probably won’t cover payroll, due to the other bills I have on autopay.

  4. […] story here on a letter she would write to Medicare and Medicaid Services if she could as follows: Dear Center for Medicare and Medicaid Services.  She would send it, if they would listen.  If they cared.  It is worth […]

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