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.
I was having coffee with a retired manager for a medical supply company. He used his expense account to the max and had open heart surgery at age 51. His wife with him had open heart surgery. He went nuts when I said MA was a bad idea. Told me I was full of crap. Raised as one of five brothers and aggressive salesman, this was par for the course. He said he was on a lot of meds, out of concern I told him to be careful with that. He got angry about that as well. I gave up. He’s killing himself as best he can. Not my business.
MA makes the US federal government out to be a sucker.
Some insurance companies are doing that with anesthesia as well. What is different in that case, it not only “rips off” the doctor, but the hospital gets dinged as well. Sicker patients need more monitoring (sometimes invasive), usually more drugs, and more recovery room time. None of it comes free. So glad I’m out of the business of medicine.
The only thing that ever worked to my advantage, our billing agent used to work both in hospital administration and for a health insurance company. So he knew all the tricks and how to counter them. He earned his keep.
The surgeon who misdiagnosed me and cut off my leg added a two-paragraph note to the operative report saying that he believed he was due a massive upcoding since the planned 90-minute procedure extended to 9 hours and early the next morning. I’m not sure how sympathetic CMS was to that reasoning.