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I
got a ticket yesterday. Darn. Oh,
not a traffic ticket. No,
this was a Medicare ticket. I
was going too slow. Okay,
well, I'd better explain. You
never know whose going to be reading a private diary like this. See,
President Johnson started Medicare. It
was a great promise. And to
get it passed, he had to drop out that the benefits might relate to
personal wealth called "means testing."
Well, it passed very easily even though it was massively under
funded. Well,
the politicians want to keep giving out more benefits even though the
Medicare bank isn't very stable. So
they have to keep pulling out money at the bottom to appear to be adding
it at the top. So
in 1999 Medicare estimated without evidence that there was a 10% fraud
factor. Well, for 1% spent on
a new army of inspectors, they could recover 9% by stopping all fraud.
That seemed like a great idea and a good way to put physicians on
the defensive. Next,
they had to define fraud. So
out came a document which suggested that unless physicians could show
notes in many categories, they could not bill for a thorough exam. Armed with such a tool the Payment Safeguard Unit branch of
the National Heritage Insurance Company branch of Health Care Financing
Administration branch of Medicare branch of Apple Pie, was ready to set
clerks on doctors. Reports of
fraud would be sought from patients with $1000 rewards.
Now,
the clever doctor-accountants came up with check off lists which showed
that you had successfully played the Bingo Board Medicare game and been
thorough. Of course, such
lists are useless as a real medical record.
Most doctors with ethics decided that they would simply write good
notes with chronic problem summaries and not play the new government game. Patient care first -- reactionary. Well,
so some months ago I had a patient who had Fibromyalgia and bipolar
problems. My history used up
fifty minutes, my physical ten, and my charting was short where there were
no findings. I put "H to F neg" for head to foot negative of
prominent abnormalities. I
was too busy trying to figure out how to get multiple records and how to
deal with her interests in alternative medications like zinc therapy. For
a while, she Emailed me with various ideas from newspaper columns written
by doctors. I was engrossed in my managed care campaigns and did not often
have time to respond. She had
no interest in Lithium; my chance for success was close to zero. One
day she got mad and turned me into Medicare for overcharging her physical.
The bill was all paid by Medicare and a coinsurance, but she (I
believe) had an interest in a potential reward.
Next thing I know, I had a payment analyst named Pat demanding all
records. She wanted a quick
response but gave only a PO box for replies; as I sought the billing
records from my outside billing, Pat got threatening. Well,
I got my ticket answer. "Services
not rendered as billed." I
owe Medicare $43.66. I have a
week to pay. (Would that they
would ever pay me in a week -- current delay is 90 days.) Five
pages of "legal authority" and threats to the future.
Not only had I committed a fraud, I was now to be watched.
If there were a pattern, I would be suspended from all government
revenue for years to come. What
fraud? My office manager
clocked me as being in the room one hour.
Notes I complete in the evening would have made in another twenty
minutes because I set up a chronic page at the same time.
So I spent 80 minutes in my office - I do not count her computer
contacts later. My
bill for a complete history and physical is the standard among GP's in
Fresno of $130. This is much
less per hour than my accountant or attorney each with about half my post
college training. A cash
patient can have it for half. My
overhead is half of what I make, which is, as you will see much less than
$130 for the service. My
bill of $130 was on the first go around discounted to $107.13 allowed.
Medicare applied their usual 20% off for the coinsurance.
They paid me $87.70 or just over a dollar an hour. After
Pat (training unclear) read my notes now in a distant city, she decided to
drop it by two levels to $52.55 allowed and $42.04 paid. This is about the level of the office expense.
So I gave the care free. Remember
that my office loses about $3000 a month already. So
Medicare is sure that the fair solution is that I work for free and be put
under a long-term watch. "On
February 23, 2000, in accordance with MCM section 7130.D, we will
automatically offset against any pending or future claims you submit
...” So I cannot hold the money until appeal or they will simply grab
the money another way. I
cannot appeal anyway because the amount is less than $100. This is all part of the Law and Regulations of Medicare.
I think all of the IRS agents have made a lateral move to this new
army. The tactics are the
same -- administrative levy. It
would appear that my entry in the chart did not "stand alone."
This means that they gave no points for creating a problem list
next to the charts notes. The problem list is the key to good health since it never
gets covered up. I taught
this to Family Practice Residents in the UC Davis program. I
guess I travel so much that I have accidentally landed in some strange
country with the bureaucrats in charge.
Certainly this is not the country set up as Jefferson's land of the
free with fair process abound. No
wonder so many would rather watch the Super Bowl than pay attention to
politics -- it is the last level playing field left. Well,
diary, I better get some rest if I am going to put in another day of free
care tomorrow. I wonder if I
can declare my office a historic monument and deduct the rent. I could give tours on what an office could have been before
Medicare. Oh,
well, I should turn on the news before hitting the pillow. Wow, President Clinton has managed to keep a lid on Medicare
costs and can now pay for seniors' pills.
What a security for my later years -- pills and no doctors.
Zzzzz. Chuck Phillips, MD Also by Dr. Phillips: |
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