Monday, March 21, 2011

Dr's Visits are going to take longer

Medicare is changing how they pay providers which impacts how long you wait to see your Doctor!
Over the next few months I will be discussing the current state of Medicare and changes that are coming from the Patient Protection and Affordable Care Act or Obama Care as some like to call it. Here is the first installment. Please post comments. Let me know your questions and thoughts on the current state of Health Care.
Your wait to see your physician will keep growing over the next several years. Medicare and Medicaid are fighting fraud by slamming your Doctor and other Healthcare Providers with mountains of paperwork. Government agencies are notorious for knee jerk reactions. Someone will point out a flaw in the way they do business, ignoring the issue for years until Budget constraints, Political Pressure or intense Media attention slaps them in the face. Then, they take action.
Part of the “Patient Protection and Affordable Care Act” sets aside 350 million dollars largely outsourced to outside agencies to curb fraud and abuse. HHS or Human Health Services reports that they have recovered 4 billion in “fraudulent” claims in 2010, but is this truth or another sleight of hand by our government? I do not disagree that they have spent 350 million dollars. I do question their claim of fraud detection. What HHS and CMS (Center for Medicare/Medicaid Services) are not telling us is that they have left the vault door unlocked and open for the past 30 plus years. “You would like to steal 50 million dollars sir? Help yourself; we will catch you in a couple of years”
They do not work like any other profitable business in the world. Businesses have Accounts Payable offices. Their function is to receive invoices, make sure the services or products were ordered and received then issue payment. This is not the way it works for Medicare. Anyone, including Nigerian, Mexican and Eastern European Criminals can come to the United States and get a Medicare provider number. They bill Medicare millions of dollars for services not provided. Medicare pays these claims without question. They refer to the procedure as “pay and chase”. The problem is that by the time they have decided to “chase”, many of these people have left the US to return to their native land with millions of US taxpayer dollars. Their new “revolutionary fraud fighting process” is to actually look at the claims prior to payment. They do not look at all of them, only a small sample to find errors in claims. This is called a Pre-Payment audit. They do not look at the simple reasonableness of the claim, but the now require up to 6 inches of paperwork to decide if your physician is correct in the assessment that you or your loved one needs a wheelchair. Gone are the days when you can take your Grandmother to the Physicians office and describe her need while the physician confirms the need with education he/she has worked so hard for. He must do face to face examinations. This is a fancy word for a lot of paperwork. He then must provide years of progress notes detailing the patient’s deterioration. People with no legs have been denied wheelchairs because the documentation and progress notes are not in the chart or not written as CMS would like them to be written. Claims are denied and eventually paid when appealed. First it was pay without question, now it is overkill with paperwork.
A great number of physicians report that they need to see 20 patients a day to break even. A physician can easily spend 18 hours a day completing paperwork to satisfy these new requirements. So be prepared to wait longer and longer, because your physician has a 6 inch stack of paperwork on one patient he/she must complete.
Did the Government actually recover 4 billion dollars or did they just delay the delivery of needed services while the actual problem still exists. It’s too easy to get a Medicare provider number. Medicare numbers are given to non-citizens that can submit claims on patients that have been dead for years and get paid.
I believe the key is to keep criminals out of the system to begin with. Could you run a business by contracting with criminals and paying them without looking at the bills? The knee jerk reaction now is treating all physicians and providers like criminals. Where is the middle ground between common sense and protecting Medicare?
I will keep writing until we have positive answer.
Michael Isbell