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Medicaid Makes Treating the Poor A Collections Hassle October 12, 2004 Editor's Note: The Doctor's Office is a new online column about the issues, challenges and rewards facing physicians today. It's written by Dr. Benjamin Brewer, 36, a solo family practitioner in Forrest, Ill. We welcome comments from physicians and patients alike. Awash in a spectrum of gold and brown, the fully ripened fields of Central Illinois are speckled with farmers combining corn and beans that will feed the world. But at the doctor's office, the harvest has been a bit slim. Dawn the bookkeeper is working to gather money owed us for our spring and summer work. The past-due accounts aren't generally the result of our farmer friends. Instead, it's the Medicaid program run by the state of Illinois that is more than four months behind in settling the accounts -- totaling $26,000 at one point. This amount covers seven deliveries, about 200 office visits and four months of hospital work. In my rural area, 25% of my practice involves low-income pregnant women, poor children and foster kids on public aid. They're the kind of people you feel bad about turning away when you're the only doctor in town. I have a nice, expensive computer system to send the claims out daily in electronic form. The state will confirm that an accurate "clean" claim is valid in about a week. But it could be weeks later before we receive a check. Toward the last quarter of the state's fiscal year ending in June, the collections process can drag out for months as the state helps itself to an interest-free loan from doctors, hospitals, nursing homes and pharmacies. Many doctors understandably don't take patients on public assistance, or they limit public-aid patients to no more than 5% of their practices. At the Republican National Convention, President Bush said every rural county in the nation should have a rural health center. Senator John Kerry's health proposal has provisions for adding more eligible people to the Medicaid rolls. Half my patients are either on Medicare or Medicaid. From the family-doctor perspective, I've got "government health care" in half my practice and government bureaucracy in all of my practice. My office is a federally designated rural health clinic located in a medically underserved area. In return for added paperwork and regulations, $5,000 per year in extra accounting expenses and intermittent inspection of my premises, the government pays me at a modestly higher Medicare and Medicaid rate. If my office wasn't involved in this special government program, the government would pay me less for practicing in a rural area than in the city for the same services. My first two years in practice, they paid at a lower rate because I was new. I have a certified medical-insurance specialist on staff with six years experience who works overtime to keep my financial house in order. I had no financial training in medical school. I'm self-educated in business, for good or bad. It takes quite a bit of effort to bill the government for a medical claim. Each Illinois Medicaid patient has a multiple-digit number on a special state eligibility document that's issued monthly. The patient's number goes on a claim form that has 38 individual sections. Some of the sections have multiple subparts. Essentially, every disease process has a special five-digit code assigned to it by a consortium of government, insurance and medical entities. The code for whatever the patient came in with that day has to be looked up and recorded on the claim form in the right spot. Every medication, test or treatment has its own number, too, and also must be recorded. There are separate reference books and computer software for all of it. Unfortunately, many of the codes change yearly. If the illness and the test number don't match up, the claim is rejected. If you use an outdated code for the same illness, test or medication, the claim is rejected. If the state isn't ready on time to accept the new codes, the claim is rejected. If anything is amiss, the claim is rejected. The privacy laws in the Health Insurance Portability and Accountability Act of 1996 necessitated changes in the claim forms, giving rise to yet another reason for the claims to be rejected. The old code for a rural health clinic office visit, W8410, wasn't good enough anymore. They wanted T1015 on Section 24c of form DPA 2360 instead. We did as instructed by the state this year and used the new codes. Turns out, they weren't ready to implement some of the new codes after all. Instead of just being rejected, this past spring $11,000 of claims for office work were marked paid at a rate of $0.00. Dawn was shocked. I was angry. If we tried to rebill the claims using the old numbers, they would reject them as duplicate claims. With payroll hanging in the balance, we called the Medicaid department. The claims would have to be "adjusted," they said. The adjustment process required manually entering and typing a different 37-space form for each of the 181 outstanding claims and submitting them to a separate department. Dawn learned from someone in the Medicaid department this summer that the actual human being adjusting the claims was 11 months behind and was working on last year's adjustments. Dawn called our state senator for help. His office was kind. We got a call from someone at the Medicaid department seemingly interested in the particulars of our situation. It was a relief just to get to beg for some mercy. Thanks to my helpful legislator, $9,000 of bills were processed and paid late last month. Now Illinois Medicaid only owes me $17,000 in back pay over 90 days. The doors are open and the lights are on for another month. Hurray. _______________________________________________ http://www.mccmedia.com/mailman/listinfo/brin-l