Bryan Johnson, MD, an internal medicine physician in Frisco, Texas, has tried hard over the past 3 years to drop all of his practice’s Medicare Advantage (MA) contracts, dropping the percentage of MA patients from 30% or 40% of his practice to 5%.
Because treating patients enrolled in MA plans costs a lot more than what the plans pay the two doctors and a PA in his practice, Johnson told MedPage Today . He also dislikes the tactics plans use to transfer beneficiaries out of fee-for-service Medicare.
some of the plans have been automatically downcoding a level 4 or 5 visit to a level 3, meaning that the amount his practice receives will be as much as 25% of the claim submitted.
When the lower payment comes through, “we see the discrepancy, so we send a letter and fight, and it may take 6 months to get reimbursed. I have my staff investing at least 6 hours just to get my claim. It could be hundreds of dollars in cost just getting the amount from the insurance company if we can get it at all.”
“We send a letter. The company says, ‘We never got the letter,’ so we send it again. Then they want the medical records to justify the code. So we send that. And then they say, ‘Oh, we never got the medical records.’ So we send them again. We’re always fighting for our money and that’s where the expense comes in.”
Delay, delay, delay.
Time value of money.
Medicare Advantage-Bad for the patient, Bad for the provider but very, very good for the insurer.
Seems like the assassination of United Healthcare CEO hasn’t changed insurer claim activity. But I bet bodyguard cost has gone way up.