The New Bounty Hunter is After You

As if the issue of slashing Medicare reimbursement by 21% is not bad enough, the government is trying to get the money that you have already received for services rendered. On March 10th, President Obama issued a directive expanding the use of “payment recapture audits” to identify and recover overpayments.

Companies are being hired as auditors to review  your claim. They will then seek return of payments made over the amount the “auditors” decide it should have been.

The government thinks that this will be a great return of investment since the amount to be recouped will be far less than the cost for these audits. As a matter of fact, there is no investment, only gain since the auditing agents will only be paid by getting a percentage of the recovered money.

Needless to say, it is not in the best interest of the auditing companies to declare the reimbursements were correct. (hardly independent and unbiased agents)

President Obama lauds Medicare’s Recovery Audit Contractor Program (RAC) for its successful identification and recovery of improper payments.

Civil penalties for persons who receive overpayments from Medicaid are now up to $10,000 for a first offense and $30,000 for repeat offenses (for each item of care, service, or supply)

The real problem here is not that there is so much fraud as much as who is determining what constitutes fraud. With lack of proper medical knowledge and experience in health procedures and coding as well as questionable objectivity,  which side of the table is really collecting the money fraudulently- the doctor rendering service or the RAC?

If President Obama had been as diligent in auditing where money went with millions of dollars in bail out funds going to banks and brokerage houses, perhaps they wouldn’t need to turn to health providers and  be so “diligent” now.

Electronic Medical Records get a New Push

This past weekend I had a great opportunity to attend a conference in Jacksonville, Florida hosted by Health 2.0.  If you are interested in this, Health 2.0 is taking the “show” on the road and will be in many geographical areas in the country over the next 4 months.

Vendors for emr systems exhibited and the displays were quite informative as were the speakers.

In attendance was a member of the Meaningful Use Committee in Washington D.C.

EMR selection can be very daunting.  Fortunately a new book is out now that walks you through the process in an easy to understand manner.  Check it out at www.emr-guide-choosing.com

Be Secure- in more ways than one!

Most healthcare professionals are concerned about security issues when dealing with conversion to electronic medical records…and rightfully so! Security problems are not to be taken lightly. The penalty for data breach has risen from $25,000 to 1.5 million as of Feb.18, 2009.

The AMA has issued a web tip sheet addressing the most common questions regarding data encryption, including what it is, how it works and the measures available to implement it. See www.ama-assn.org/ama1/pub/upload/mm/368/hipaa-phi-encrption.pdf

According to Red Flag Laws that have been reviewed in a previous newsletter, breaches in health record security must be followed by notifications to patients in accordance with the Health Insurance Portability and Accountability Act.

If you encrypt your data, however, you are exempt from the notification requirement.

A survey conducted by HIMSS found that only 39% of mobile device transmission was encrypted, 44% was encrypted when stored and only 67% of data was encrypted for transmission.

Evidently, we have a distance to go.

Center for Medicare and Medicaid Innovation Emerging

As of March 1 of this year, Medicare payments to physicians are being slashed 21%.  How physicians can survive on these cuts to their reimbursement and still see Medicare patients (and meet their expenses) has not been addressed.

Instead, Congress proposes forming a Center for Medicare and Medicaid Innovation (CMI) to transition delivery-system changes.  The CMI would be delegated to testing creative payment and service-delivery models aimed at reducing Medicare and Medicaid expenditures while improving the quality of care. Electronic medical records with exchange of data and interoperability will play a key role.

In this proposal, innovation to healthcare delivery is encouraged by  uncoupling the link between service volume and provider revenue.

This may sound great to the public, but what about the physician?  Is he supposed to slave away in his office without reimbursement because it is for “the good of the public” or because it will effect national healthcare spending in the long run?

What about the physicians in the short run?  Will there be physicians that survive in private practice for the long haul or is this a governmental technique to phase out a way that you can consult privately with your doctor?

Again, a national health insurance coverage to see physicians will be useless if there are no physicians to see!

Medicare Slashing Postponed by Senate Vote

Medicare physicians can breathe a sigh of relief once again as the Senate voted 289 to 112 delaying the Medicare cut once again until June 1. The measure now awaits President Obama’s signature.

CMS (centers for Medicare and Medicaid) will now begin processing the claims that were sent in for medical services rendered but held off (from April 1) enabling the older submissions to be paid at the original rate.

As stated in an earlier blog, it is not just seniors that are effected by the delay in this bill. The Medicare cuts are part of a bill that also covers unemployed Americans under COBRA for compensation benefits and health insurance premium subsidies.

So for now, it is business as usual.  How long that will be, is anyone’s guess.

Having Medical Insurance is Meaningless

Medicare reductions are technically in effect now since April 1 when it was scheduled to be slashed by 21%. Fortunately, physicians are currently being protected from the onslaught by the CMS (Center for Medicare and Medicaid Services) who are delaying claims submitted for this month in the hopes that the decrease in the fee schedule will be negated…at least temporarily.

Private health practices will find it increasingly difficult to stay solvent if they depend on Medicare and third party payers to subsidize their operating costs.

Not in Medicare yet and feel that you are not affected?

Wrong!!!  Most insurance companies base their fee schedule on Medicare rates, so if you are covered currently under a policy  with private insurance, you are still affected.

The House has approved a bill postponing Medicare reductions but is waiting for Senate approval.  Senator Baucus, chairing the Senate Finance Committee, has proposed an amendment to delay the bill for an extra month.

What we need is to devise a fair reimbursement plan to healthcare providers instead of delaying (but keeping in place) a cut to the reimbursement plan that is currently in effect.

Having medical insurance will be meaningless if there is no healthcare provider to see you.

Medicare cuts delayed

Whew, we dodged the bullet for a little while at least!

The Senate agreed to vote on a bill delaying 21.2% Medicare slashing for doctors from April 1 to May 1. The bill would also extend unemployment compensation benefits and COBRA as well as some tax breaks. Though Democrats in Congress have set the clock to October 1 for the reduction with a possible freezing of the cut for five years.

Republicans criticized the bill for contributing to the federal deficit.

CMS- the Centers for Medicare and Medicaid Services will cut checks for the full amount owed on services rendered if the Senate extends the effective date.

It is a relief to see that Congress realizes the havoc that would occur if Medicare cuts were indeed taking place.

After passing a bill that will cost the American people 1 trillion dollars, worrying about the deficit is hardly going to make a dent in the real problem.

Thank goodness  they came to their senses!

Congress Should have the Same Health Plan as You

Today, I received an email which is being passed around.  I am thrilled to be able to forward it as it spreads the thought that I have been espousing for a long time.  Thank goodness we have some legislators that recognize the fact that they should not be above the laws that they pass for others.  That is the only true way that we will get fair healthcare reform and governmental policies.

Please read it and act upon it- because if you remain passive- it will be acted upon YOU!

On Tuesday, the Senate health committee voted 12-11 in favor of a two-page amendment that would require all Members and their staffs to enroll in any new government-run health plan.


Our congressmen and senators should drink at the same trough!


Three cheers for Congressman John Fleming of Louisiana!
Congressman John Fleming ( Louisiana physician) has proposed an amendment that would require congressmen and senators to take the same healthcare plan they force on us (under proposed legislation they are curiously exempt).

Congressman Fleming is encouraging people to go on his Website and Sign his petition (very simple – just email).


I have just done just that at:
http://fleming.house.gov/index.cfm?sectionid=55

Be sure to put in your e-mail address.

Please urge as many people as you can to do the same!
The Congress should have to accept the same level of health care for themselves and their families.


To do otherwise is the height of hypocrisy!

Please pass this on !!!

Doctors-the New Downtrodden- in Sentiment at least

To get some sense of what the community of American physicians and healthcare providers think of healthcare in the future with the new legislation, Athena Health took a survey of 1,000 physicians. These doctors represented the full gamut of practice sizes, geographical areas and specialties.

When asked ”if more government involvement in healthcare will help”, 54% denied this.

Much more than half of physicians felt that the quality of medicine in the U.S. will deteriorate in the next 5 years with clinical decisions “based more on what payers will cover than what is best for their patients”.

In terms of reimbursement, 92% felt that “getting paid by insurers has become increasingly burdensome and complex” with 83% stating that this is true for Medicaid and 81% say this applies to Medicare as well.

This is what the administration may be banking on to lower costs.  Yet what will the outcome be?

  • Loss of the best minds to business instead of medicine
  • Increase cost to patients who want treatment options that really work,not just ones the insurance will cover
  • Decrease of private practice due to increasing overhead expense and decrease reimbursement
  • The disappearance of private practice, not just the decline
If you thought that the healthcare system was in trouble before this new legislation, you have not seen problems that will soon arrive in epic proportions.
Be afraid…..be very afraid!
(Now, go  DO something- vote in new Congressmen, let them know where you stand before it’s too late and has spiraled out of control!)

Government says that medical specialties are not all that special!

The Obama administration has made clear their desire to increase family practice physicians over those who specialize.  Pulling the salary or reimbursement card is the way that they will coerce young graduates. While Medicare is carving away 30% payment for services rendered by cardiologists, primary care was raised 4%.

Starting January 1, Medicare slashed reimbursement to cardiologists for “expensive tests”.  They were referring to echocardiograms and stress tests. While these tests may be deemed expensive, they are by no means ones that can be dispensed with.  Yet again, the elderly and disabled individuals in our community are being targeted.

The American College of Cardiology has filed a complaint against Medicare but to date, the federal court has turned a deaf ear.  The result will endanger free telephone consultations and increase out of pocket expenses for patients.

Though we do need family practice doctors, let’s face it.  When a patient comes into the office with an intricate problem, he is referred to the specialist, so let’s make sure that we keep them available!