family practice issues and general life events

Posts tagged ‘EHR’

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only to be told to look at their website, which for the longest time said absolutely nothing, and then eventually outdated and somewhat misleading information.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

Yesterday, I almost kicked my computer out the window

In my 2 month long saga (of which I was only aware of for a month) of not getting paid, I continued to do my job, and provide the best care for my patients that I could.  I was still seeing between 25 and 35 patients a day, and trying to get them referred to specialists, and watch their lab, ordered MRIs, XRays, mammograms, and CTs as indicated, and tried to adjust medication.  All fairly ordinary in a day’s work for me. I became frustrated with some patients and specialists, and others were easy and pleasant to see and talk to.  Still fairly routine.

However, the one thing that was constant, is that I was still using a computer through it all to track everything.  On Tuesday afternoon, the internet went down.  Don’t know why, but we were still able to work on our internal network.  No internet, made things harder like checking eligibility, taking credit card payments, and other tasks, but life was not impossible  However, that evening, my software started popping up that our licenses were not active and that further use of the software might result in errors and damage.  What!  I paid my yearly contract in August, and well it is February.  The day finished, and we noticed updates had not been installed on the server, so thinking that might have been one of the internet problems, my husband restarted and installed the updates.  During this time I wrote an angry email to my EHR vendor, pretty much expressing in it all of the frustrations we have had with them in the last 6 months, and especially the last month and a half.  Not expecting a response until morning, as it was 5 pm when I sent it, I was really surprised at the first response in 10 minutes, followed by another 4 in over the next 20 minutes.  I guess threatening to find a new vendor (which can be pricy, mine cost around $30,000 for two physicians 6 years ago) is enough to warrant prompt attention.

Anyway, there was only so much that could be done that night, with the server updating, I don’t know how many updates that night.  So I went on with my night, and yesterday morning, still the same error message and my tablet (which I take room to room) would not connect onto the network.  Actually none of the computers that were on the wireless would connect.  So we followed the directions to fix the licensing issue, pulled out our paper charts that we have for an emergency, and started the day.  However, we got to one step that said, clicking yes will disconnect you from your system.  And the directions clearly said to click yes. Oh my.  Did we want to do this?  At this point, I am definitely ready to throw my computer out the window and look into new lines of work.  Not sure what I am qualified for, but they surely pay better (since I am not getting paid) and probably 100% less stress. 

At this point, the wireless connection was reset and the tablet was working, so we were electing to not fixing the error, because despite the error messages, we could at least access the chart.  But how frustrating.  Though somewhere during the first hour of patients, apparently my office manager had gotten ahold of support, who said there would be no effect to the rest of the system when pressing those buttons, and had fixed the licensing issue.  So if I would log out and log back in, I would not longer be bothered by the annoying error message that I had not active licenses.  Finally, some good news.  Anyway, we were finally able to finish the morning, but the right off the back frustration makes me wonder, do computers make it easier or more difficult?  It is hard to decide.

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.

CMS blocks payments to providers through firewall

The Centers for Medicare and Medicaid services have found a way to save money.  They simply installed a firewall which blocked claims submission from providers who have complied with the 5010 conversion by January 1, 2012, which was their initial deadline.  And the best part, most providers did not realize the problem until the end of January.  In what has been one of the worst weeks in my life at the office, we received a phone call on Tuesday, from another office who used the same EHR and the same interface processing claims asking if we had been paid this month from either Medicare or Medicaid.  The answer was, yes.  Well initially it was yes.  Followed by “Well only by Medicaid.”  Followed by, “Well outside of our medical home payment about $18.22.”

WHAT!

Throughout this month, I have been watching the income come in.  And until about the middle of the month, it was about the same as last year, maybe even a little more.  And while I was not thrilled with that considering there was more patients 45 days before than there had been a year ago, money was still coming in.  And we had already found that there was a problem with a glitch in our billing and were attempting to locate it.  So I was already not taking a paycheck this month.  So at least my salary was not affecting the outgoing.

However, as the month went on, that number seemed to not change the way that it was supposed to.  Well, we are looking for it on the one hand, but last Thursday, we underwent an audit from Medicaid, so much of our effort went to preparing for that.  Making sure that all of our i’s were dotted and our t’s were crossed.  Knowing that no matter what they would find something wrong.  Realizing too late, that after our last COLA inspection, our CLIA certificate seemed to not be put back in the same place, and was currently MIA.  Which is not great news, especially since a computer glitch at CLIA has not allowed them to send new certificates out, and we are still waiting today for the request submitted two weeks ago.

So anyway, while the numbers were concerning, they were not in the front of our mind, until Tuesday.  When a call partner called, and we looked.  And then discovered.  We had not heard anything from our clearing house all month regarding claims.  So we examined further, and that $18.22 was from Medicaid secondary payment which was submitted to Medicare prior to January 1.

So we called our interface to find out what happened.  “You are currently 1,746 in line.  Approximate wait time is 7 hours 32 minutes.  Did you know that you can check wait times online visit www….”

Well that sounds, uh promising.  After utilizing a phone line for the entire day, we found out, that there was the problem, they were contacting our EHR, and no they don’t know when it will be fixed.  That was tuesday.

Wednesday, we found out that it was not just our EHR having problems.  It was multiple EHRs.  And we started looking for a new way.  We had recently hired a new billing company, who was in the process of creating tunnels and whatever else is required for them to extract our data over the internet and bill for us, would they be able to take our Medicaid claims and submit them an alternative way?  The answer was maybe, if we can figure out how to extract them from the mess, we currently were in.  (Then tragedy struck our office Wednesday afternoon, and to be honest, we just tried to finish our day)

Thursday morning, numb and still in shock, we checked by on the Gateway.  Still no payment, but there was something that had not been there in a month.  A screen of rejections.  We don’t know if that is a good sign or not, but it was something new.  Still no payment.  But a new screen.  And the interface was still working on the problem.  (However, this did not prevent them from drafting my account for payment earlier in the month)

Finally, Friday morning came some answers.  Calls to Medicaid to make sure that we would not get hit with a penalty for attempting to file claims multiple ways, which received a probably not, also had some news.  Apparently the day before, they received 18 electronic batches through interfaces.  While they did not know if they were ours, they said it was promising only because they had not received anything the entire month of January.  Nice.  And you could not have said anything to your providers?

And Friday morning, also provided word from our clearing house.  Apparently the 5010 conversion had caused this.  Despite providers, software vendors and electronic interfaces having had successful tests from the previous year, January 1, conversion did not go as planned.  A firewall at CMS enacted for this event, did not recognized claims that were in compliance or not.  It did not recognize NPI numbers, ICD-9 codes, or CLIA numbers.  In an essence, those who complied with the rules by the initial deadline were penalized and just not paid.  This included all federal government programs Medicare, Medicaid, and Tricare.  Well actually Tricare was worse, their firewall had been blocking claims since November.  And our situation could have been worse, there were Medicare providers who had not been paid since November.  And this is for those that comply with their rules.

Unfortunately for me, 45% of my income is from Medicaid, 20% from Medicare, and Tricare <1%.  So you can imagine what this is doing to us.  The only thing good with regards to Medicare is that we collected their deductibles up front, so we did get some of that.  Though there were also glitches with Blue Cross Blue Shield which is our 3rd biggest payor, which has a percentage close to that of Medicare.  So I guess that I am lucky that I am sitting at half of the number that I should be.  Next month figures to be worse, when you consider a 45 day wait time for Medicare on average.  If we can get claims through under Medicaid, I should get paid in as quick as a week after submission.

So the month of January, I have worked for free.  February, I will also not be taking home a paycheck, and I imagine it will be close to May, since March and April will require me to catch up on bills not paid this month due to the CMS firewall.  Which means more shifts in the ER for the hubby, so that we can survive at home, since my bills won’t stop.

So those of you who think physicians are just greedy, and should be willing to take a 27% cut in pay from Medicare (which would result in similar cuts from other insurances) consider this.  My overhead does not decrease, it increases.  I still have to pay my staff, rent, electric, water, etc.  And following this incident for being in compliance… it is no wonder that physicians don’t trust CMS.  I have not committed fraud, and have played by the rules.  But situations like this sometimes makes you wonder why you bother.

So before any of you call your physician greedy or just in it for the money, think about this.  Those that are self employed didn’t get paid this last month at all, and will probably not get paid this month (take home pay).  The fact that they don’t trust CMS results from issues such as this.  And that is not even looking at the cluster that is ObamaCare.  So I worked last month seeing patients for free, will next month as well.  Sometimes you have to wonder if that time wouldn’t have been spent better elsewhere.

So I guess CMS has come up with an ingenious plan to save money.  Just block physician claims from going through at all.  That way, their money is able to stay in their account and draw interest, and well unless providers close their doors overnight, their patients are still being seen at least temporarily.  So if you look at the numbers for January for CMS, I am sure they look the best in a decade.  Thanks CMS.

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