family practice issues and general life events

Posts tagged ‘billing’

My 5010 nightmare- maybe coming to a close?

It has been a little longer than normal since I have posted, and my excuse is that I have been busy.  Not that everyone else hasn’t been, but well work life seems to have been busier than normal.  Previously, I have written blogs about a firewall that was blocking payments and how I could not get through, and that maybe things were finally getting better and they are.  This week we finally got our first check from Medicare for claims since 12/19/2011.  It was for $12.45.  Woohoo, I can finally retire!

I laugh because I actually think that it is hilarious, all this time and work, and complaining about not getting paid for almost 3 months, and when we finally get through, the amount is not quite the amount you expect, because the deductible started over on January 1, and most of the claims on that sheet went to deductible.  All this work and time waiting, listening to the crickets chirp.  Or wishing their were crickets chirping, because it would be something better than silence.

After this time, arguing with the clearing house about their responsibility only to be told to look at their website, which for the longest time said absolutely nothing, and then eventually outdated and somewhat misleading information.

First it was my fault, no, it wasn’t.  I did all the steps, I was told were required for a smooth transition.

Then it was my EMR vendors fault.  Well,. they sent me a new update on January 1, which was downloaded within that week.  Followed by one more update the end of the month.  So maybe slightly- though I did send them a not so nice email as well during my frustration, to which they replied within 10 minutes intially, and then 5 more times within 30 minutes and able to fix the problem by the next morning, and considering it was 5 pm when I sent the first email, I was happy enough with their response.

So that takes me to the end of January, where the clearinghouse has yet to notify me of any problems, or to answer why I have not heard anything in a month from ANYONE (insurances included) to looking at my balance sheet saying “Holy (insert profanity here)!  Why haven’t I gotten paid.  How am I going to make my bills, pay my employees, …”  To only get told I am 1700 in line with a waiting time of 7 and a half hours.  Well that was when their system did not cut me off and hang up on me.  And after all that time I was on hold what was their answer.  “Well you should look at our website daily.”  Well at least they are consistant.  Though they continue to refuse to answer my question “how can you take my money without at least warning me that there is a problem?”  Their answer is still I am sorry for your difficulties and your disatisfaction, but we post things on our website daily.  You should read that.  And when I threaten to leave them, it isn’t any better.  Still with the damn website quote, and does not answer my question, and that I am required to give them 30 days written notice.  Which I will, as soon as I know I am up and running with the new group.  Just have to wait for Medicare approval.

Finally, the clearing house appears to have gotten their job done (only 60 days late, and not willing to take any responsibility).  However, that day Trailblazer crashed.  Nice.  It takes them about 4 or 5 days to get back up and going, and then we get messages that we are not an eligible provider.  Apparently even though Medicare claims that our contract is still good so far this year (we will have to renew this year, it is just not our turn yet) Trailblazer has forgotten to tell us, we need to sign a new form.  OK done.  Now for the new denials- all of our claims are duplicate claims.  Seriously?  It is a wonder, I haven’t gone postal yet.  All of this, filing and refiliing, denials and everything else to get the anti-climatic check of $12.45.  Awesome

However, I have gotten in contact with some great people that have helped.  Apparently, I helped my professional organization find out there was a problem, and they narrowed it down to Trailblazer having the biggest issues.  They determined that the physicians in Oklahoma and Texas appeared to be having the biggest problems.  Talking to some billers across the country, those using a clearing house seemed to have more problems than those that didn’t.  So guess what?  I had both issues.

And in the middle of this all, apparently Trailblazer is installing new software to help fix the problem (which apparently started last year)  I have heard from my congressman and Senator and one state Senator, but since things are improving we are hesitant to have them do anything.  Because there is no desire to cause further stalling on the issue, especially now that payments (did I mention $12.45) are finally slowly coming in.

As for my relationship with my clearinghouse- Well it will come to an end when I receive approval from Medicare for my new billing company to file how the prefer to do it.  After 6 years, I think it is time, and my loyalty apparently means little to them.  But I did let my colleagues in the area know that their clearinghouse was at least partially responsible for them not getting paid.  Helpful website indeed.

But I had good news on Thursday, I finally had enough money to catch up all of my bills.  I didn’t have to take out a loan.  I still didn’t get to take home a paycheck, nor did my husband, but maybe next month.  It is really sad that Wednesday, I saw 40 patients, and my hubby saw 33 patients in the office and 7 in the hospital, and we were longing for the days that we saw 17 and took home a paycheck.  But maybe as things start rolling, we will be able to see some of what we have worked for.  I hope so, because I didn’t go to medical school hoping to support 6 other people and not get paid myself  (we are now down 2 employees, after one dying at the beginning of the month, and the other being fired).

Anyway, as the computer glitches resolve, we will move foward.  Looking ahead to the crashes and glitches that will come with the conversion to ICD-10.  Oh happy days ahead/

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A light at the end of the tunnel (OH I do hope it is not a train)

Finally after 8 weeks of not getting paid by Medicare, and 6 weeks of not getting paid by Medicaid, maybe there is hope.  Talking to my fellow physicians have helped.  Sadly the fact that knowing I am not alone and the biggest idiot with regards to payment ever has comforted me. For the first time in my life the expresssion, misery loves company actually does apply.  Not that I wanted them to have any difficulties, but for a bit, I thought maybe I was alone.  Being alone, would mean that it was all my fault, having company means there must be something in the system that is tragecially wrong.

Anyway, the new company that we had contracted took over the Medicaid billing immediately, and did get us some cash, unfortunately the Oklahoma Medicaid site crashed on Friday, and was not back up until Wednesday.  It still is not fully functional, but at least claims can be inputted back in.  (Probably due to all the desperate physicians in the state who had been using a clearinghouse to submit claims jumping on in droves desperate for some cash flow, that is just my opinion, but it is as likely as anything else.)

And Thursday morning, we were told that all of the updates from both the EHR vendor and the interface were finally complete.  (These are updates that have been released since the first of the year, and probably since the date we found out there was a problem, not due to any negligence on my part.)  And we were free to resubmit all claims.  Which means we get to go through and find all of the claims that we have submitted since December 19, and start all over again.  What fun will that be!

I spent Friday with the company that we had hired to start doing our billing (because we had a problem before the 5010 conversion almost bankrupted me, it only made it worse).  We were showing them the ins and outs of our system, and while showing them how to do somethings, we were able to understand some of the issues that we have been having.  Unfortunately the person who was responsible for inputing payment in never brought that issue to our attention.  But it will be fixed immediately.

As for our Clearinghouse, I understand that you were probably overwhelmed, but seriously, couldn’t you have given at least a heads up.  Some of us were in the middle of a Medicaid audit so it took a little longer to realize the problem.  You should have posted something immediately.  You were only too happy to take my money.  And the email you sent me saying you were looking into the issue, still has yet to address any of the concerns we have.  And your customer service response of “well look at our website.”  Which we had already looked at, and it said nothing, left much to be desired.  So any thoughts we had about retaining your services have been removed.  We will probably convert from you over the next month, after being a customer for almost 6 years now.

To my elected officials, I will keep you lack of response in mind when it comes to your re-election campaigns.  I received one confirmatory email which the senator will try to respond in the next month.  I guess you all were too concerned about issues of birth control (both state and nationwide) to think about whether physicians would even still be in practice in 3 months to prescribe the pills.

For all of you with your kind words of support, thank you.  I do appreciate it, and send happy thoughts back to you.  This year, so far has not been the one that I would like to repeat so far.  This conversion has really opened my eyes about future conversions.  I am not worried about ICD-10 for the coding issue, but for the computer conversion issue.  IF this is a taste of what is to come when that happens, well I am not sure that I have the desire to continue.

When too much is never enough

I accepted a while back that I could not do everything.  I was not going to be the mother who volunteered for everything for their child’s school, the doctor who completely immersed themselves in their patients lives with no regard for their own, or the best friend that is always available.  Frankly most of my time is spent between physician and mother, I have few friends that I talk to on a regular basis, and even fewer that I see regularly.  This is ok, life is about choices, and sometimes we sacrifice one area for another.

 

However, we are currently undergoing some major changes at my clinic.  Were they necessary, could they have been prevented?  I don’t know.  I don’t know if they came about while I was spending extra time focused on my boys and taking care of their needs, and taking a much-needed vacation.  Well, actually I do know that the vacation had little to do with the changes needing to be made, but it could have resulted from time I was focusing on my children and elsewhere.

 

By the end of this month, all of my staff will be brand new, i.e. working for me for less than 3 months and not yet qualifying for benefits.  One of my front office is brand new, and we are attempting to convert to an outside billing system.  This was previously done in-house, and due to increasing requirements on time and needing to move staff around to cover holes, we have overlooked probably the most important aspect of any company revenue collections.  We are busier than ever and doing the work required to earn income, just seeming to miss the step of actually collecting that money.  I spent my Saturday morning looking at the Accounts Receivable for the past year, and it was terrible and depressing.  How did I miss it?  Well I can give you excuses of well I have been seeing more patients than ever, I have been trying to be a good mother, I have been trying to be a good citizen, and the list goes on.

 

We have known for a couple of months that we needed help.  In fact, we have been looking for someone qualified and fully trained for about 3 months.  The only takers have been, people neither trained nor having any experience, all wishing to tell me that they are fast learners.  Unfortunately, I have neither the time nor the desire to train someone for this all important job.  Add to that, I would argue that I am not the best one to train another for this job.  There are programs that certify people for this, and I am not certified, but I know probably as well as any physician, and maybe even better than most.  However, I do not know the tricks to fight for my money or all of the other little insights into being a successful biller or coder.  So we have decided to go out.  And let someone else try it for a while.  This is not to say that my employee hasn’t been trying, however, since we terminated another in the front, we had to move her around doing other jobs, leaving the vital job undone.

 

The other area we have a recent upheaval is our nursing staff.  We witnessed a recent surge in patients which was more than the two nurses we had could handle.  Again we had difficulty filling the position.  Whether it was the potential wanting to much money, not wanting to work as much, or other it took longer than we thought that it would.  Almost immediately after filling the first position, my long time nurse informs me that her husband is being transferred, so I would still have to find another nurse.  So we continue our search, only to be given notice by another nurse, stating that the hours, stress and money had been beat by another group.  So she was also leaving.

 

I have a problem with faulting myself for this situation, since we were attempting to alleviate some of the load and stress, however, anyone who has ever hired employees knows, the right fit is important.  A combination of work ethic and personality are very important.  However, maybe this is good.  It allows us to re-examine the work flow and find where the critical errors are.  There are issues we have been noticing for a while, but did not know how to fix.  Maybe a fresh slate is what is needed with new ideas to fix this.

 

The good news to this story is Monday morning, we will have a full slate of employees.  Actually one extra since my nurse who is moving is there until the end of the month, and can help train.  Maybe it will help with the morale of the clinic, all new employees.  There are advantages of starting fresh, however, there will be a slow down due to the need to train the new staff.  I will continue to wonder if there was something I could have done to prevent this drastic overhaul, but will never know for sure.  However, hindsight is always 20-20, but I did not have the ability to see it so clearly before.

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