family practice issues and general life events

Posts tagged ‘Medicaid’

To all my friends in the medical field

Dear friends-

This blog is for you.  while there is no difficulty in others reading it, this one concerns you all directly.  Well at least those of you who accept Medicare, Medicaid and TriCare.  (If there is a federally funded carrier that I missed, I apologize, and advise you to check on them as well).  Look and see if any of your Medicare claims submitted after December 19, have been received, paid or rejected.  And then look at your Medicaid claims and see it they have been paid.  (In Oklahoma, look after December 28).  If the answer is yes, well then never mind.  If not well, it is your attention that I am seeking.

I understand this does not affect physicians that work at the VA, many of the Indian Clinics, and possibly those that are federally funded, but for the rest of you, this absolutely affects you, whether in practice for yourself, a small group, or those employed by a hospital.  CMS has installed firewalls blocking claims from getting through.  This is not just for providers who are not 5010 compliant.  I went through all the steps required to be compliant, and my payments have been blocked.  This is not just the 2 week delay we were told to anticipate for the 5010 conversion.  This is a complete block that appears to not be vendor specific nor clearing house specific.  

After checking those of you who have found this to be true that you have not been paid by those under the umbrella of CMS, I am asking for your help.  I have attempted to contact CMS and cannot get through.  Their email addresses are only for those who wish to report fraud either on themselves or someone else.  I am asking you to take the time to write your Senators and Congressmen/women, in order to get this situation fixed.  If not, many of us in smaller clinics have only a small amount of time left.  

This is not about greed, this is about getting paid for services you provided.  Last week, I had to pay my staff’s payroll partially out of my own bank account.  If you want to write it off as bad business decisions that is fine.  I have made some, but realize that if you are not getting reimbursed, at some point you will find that you also are unable to practice medicine.  I am not asking for money that is not mine, only what I have earned.  I cannot continue practicing without income coming in.  My practice is 45% Medicaid and 25% Medicare.  How long could any of you go without receiving payment from 70% of your patients?  

And for those of you who accept neither, ask yourself what will happen if Medicare and Medicaid are allowed to get away without paying?  What will happen to the rates to your private insurance payments?  And those in the Emergency Rooms- where do you think that those patients that can no longer see their physician will end up?  I am just asking that you write your Senators and Congress for help to end this block so that we as physicians can get paid for what we have done.  I have not committed fraud, and I have followed the rules.  And following the rules has led to me being within two weeks of being forced to close my office, because that is the reality.  I cannot afford to bankroll my staff any longer than that.  They say you should find a career you would do for free, I have been doing that since the end of December, I cannot see myself paying to do this for long.

Thank you for your time and any effort you put towards my cause, and for many of you, your own cause. 

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.

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