Payment problems?
TMA’s Hassle Factor Log can help. Physician members can get help with pay- ment issues by using the TMA Payment Advocacy Department’s Hassle Factor Log. The program helps doctors bring their insurance-related issues to TMA’s attention so staff can investigate problems and work with private health plans, Medicaid, and Medicare to get claims paid correctly. Download the Hassle
Factor Log, and learn more about the program at
www.texmed.org /hassle, or email the TMA Payment Advocacy staff for assistance at payment
advocacy@texmed.org. You also may contact the TMA Knowledge Center at (800) 880-7955 or at
knowledge@texmed.org.
related to the smoking cessation measures she reported in 2013. To find those patients, however, Dr. Chesnut had to go back through records for all of the 134 patients she reported on that year. The letter then instructed her to create an encrypted, de-identified spreadsheet with the information to send to Arch Systems. Fortunately, she could use a free trial offer on the specific software required because hers was not compatible. Of the 30 records, the reviewer selected eight to review in more depth and
gave Dr. Chesnut one business day to turn over the corresponding documenta- tion and patient charts. Fortunately, those eight records were enough to comply with the specifications for the smoking cessation measures. If not, Dr. Chesnut would have had to turn over documentation for the remaining 22 patients. “We are a tiny office. It’s just me and one other doctor — no office manager —
so it’s all me staying up until midnight doing these charts. And what they asked for was more detailed documentation than what we did when we first reported the measures. It seems to me the criteria should be the same,” she said. In 2014, Dr. Chesnut’s PQRS bonus payment was $534. “This is a lot more auditing than what they paid me.” She says it’s these kinds of hassles that pushed her to change her status to a
non-PAR Medicare provider in 2011. She and her partner have considered leav- ing the program entirely due to the ramp-up of measures reporting and penalties under the meaningful use program. “I am relieved that the SGR has been repealed, as this was a cause for major financial concern — and the motivation for going non-PAR — every time it came up for approval,” Dr. Chesnut said. But she’s still reserving her overall enthusi- asm until the finer details about the new Medicare program emerge. “I still believe that the challenge with Medicare is that these patients tend to
be complex patients with complex medical and social needs,” and physicians are still expected to care for them for inadequate pay while enduring constantly changing performance measurement, she said, “which breaks my heart because I truly enjoy taking care of these patients.”
MEDICARE MISCALCULATIONS Even non-PAR status didn’t shield Austin Internal Medicine Associates from more Medicare bungling. The group does not participate in Medicare but still sees those loyal patients
who’ve been with the practice for decades, about half of the practice’s patient population. Rather than dealing with Medicare billing, nonparticipating status allows doctors to collect a set amount up front for their services, and Medicare reimburses the patients. But problems on CMS’ end could have cost Austin Internal Medicine As-
sociates those long-term relationships: Practice Manager Janet Ream noticed the monthly explanation of benefits (EOB) notices she started receiving in late January and early February did not match the fee schedule she says she me- ticulously follows, making it look like the group had overcharged its patients. Patients eventually get those notices, too, on a quarterly basis. “It makes us look like criminals,” she said. With no answers from CMS, Ms.
Ream also immediately turned to TMA. TMA discovered non-PAR physicians are, in fact, not over-collecting. Rather,
the discrepancies stemmed from technical errors in an early draft of the 2015 Physician Fee Schedule. CMS issued a revised schedule in January, but the mis- takes had trickled down to the master database contractors use to process physi- cian claims, TMA Director for Payment Advocacy Genevieve Davis says. CMS did not correct the database until early February. Meanwhile, Medicare con- tractors continued to print erroneous EOBs. (See “Payment Problems?” at left.)
28 TEXAS MEDICINE July 2015
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