family practice issues and general life events

Posts tagged ‘firewall’

Dear Center for Medicare and Medicaid Services

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.

Advertisements

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.

Tag Cloud