family practice issues and general life events

Posts tagged ‘clearinghouse’

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only to be told to look at their website, which for the longest time said absolutely nothing, and then eventually outdated and somewhat misleading information.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.

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