Topic: Learning along the way
As many of you know, come October 1, 2007, I'll be heading into the
wonderful world of "private practice". As someone who prided himself
in constantly being educated in the areas of practice management,
billing and coding, etc, it's actually been a very frustrating
experience.
Not frustrating from a lack of understanding, but rather from the
fact that I have ZERO negotiating power. Third party payors are
holding nearly all the marbles. Now, this is certainly not a posting
to advocate for a single-payor healthcare system, which would be a
complete disaster, but rather a deeper realization of how bass-
ackwards the "system" is.
For example, typically when you "contract" with someone to perform a
job, the involved parties agree on some basic tenets...I'd like to
have the project completed by such-and-such a time and I'd like it
done within certain parameters; sky blue, not navy blue; all 4 walls
rather than just 3. I'm not going to dictate to you how you actually
paint a wall, but rather judge the work process by the end result.
This is not the case with the "practice" of medicine. Over the next
few blog postings, I'll be sharing some seemingly odd discrepancies
in the professional agreements or "contracts" physicians have with
payors (ie, insurance carries), but let me begin with a payor near
and dear to my heart (cough - cough)....Medicare.
About 2 months ago, and knowing I would be moving into private
practice, I contacted our lovely government-run insurance carrier.
You know one of the ones which we as tax payers dump loads of money
into? I contacted them seemingly far enough in advance to prevent
any delay in the "credentialling" process and to ensure that all of
my contact information, etc was updated.
As I would be forming a group practice, I would need to apply for a
Group NPI (national provider identification) on top of my already
existing personal NPI, UPIN (universal physician identification
number) and Medicare ID number. Now one would think that a single ID
# would suffice. "We" were told that at some point it
"will" (although everyone was supposed to adopt this new-and-improved
system in May, 2007) be adopted as THE number physicians and
provider are assigned and all previous numbers would evaporate.
So, like a good little compliant physician, I complete the...hmmm...5
forms??? and submitted then, as directed and with enough advance
notice that by opening day everything would be in order.
This past Monday I received notification that I had submitted my
paperwork "too soon" and would have to resubmit every wonderful piece
of paperwork within the "mandated" 30-day window. Now here's one of
the catches...you can't submit it until within 30-days of your new
office, but Medicare has up to 120 days to review and if everything
is in order, stamp the necessary paperwork with the almighty
"approved" designation.
When I questioned the representative about this because frankly it
doesn't make sense that I had to submit the documents within 30 days,
but they can take an additional 90 to "review things", I was, in so
many words, told....silly Doctor, Trix are for kids!
So, my options at this point include:
1. crap load of prayer that everything will be in order
2. float the gov't a loan by seeing Medicare patients over the next
couple of months and provided all of my documents are in order,
submit the claims afterward. So, if I see half a dozen Medicare
patients.....let's do the math....heck, it's too late for math, but
the long and short of it is that I'll be dutifully providing medical
services which may or may not be reimbursed in a timely fashion and
not until after it's been proven that I am a physician and in fact,
do care for Medicare patients.
An additional frustration is that this is now the 3rd time I've had
to go through this process in the past 5 years. I feel fortunate
because I have way too much time on my hands and I couldn't be more
thankful that the gov't gives me the opportunity to keep myself
occupied with the revolving door of credentialling.
Now, of course, it is now 48 hours + since receiving the notification
above and although I was assured that "I'll call you back", I've not
heard hide nor tail of the representative (or stand-in) that I spoke
with. Patients is a virtue, but really.....
So, we'll see what happens over the course of the next day or so and
hopefully if I don't get a response by Friday, see if anyone actually
remembers the on-going conversations I've had this week and last
Stay tuned........
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