I took a little time off to focus on my new part-time private practice and Family Medicine payment model. Now that it’s up and running, I look around and the healthcare system still stinks, so I guess I’ll keep writing. My payment model is available for any U.S. Family physician at www.sentirecare.com. I also have a youtube channel with explanatory and training videos. Just search “sentire care”.
This is a true story I’m about to tell you: a friend-of-a-friend story. I don’t know the family physician this happened to, but the source is completely reliable.
A doctor had one of his Medicare patients on a Chronic Care Management plan. This meant that he or his staff, probably mostly his staff, called or visited some high need patients on a monthly basis. Medicare now allows Family Physicians to bill for this service, but the patient still has to pay a co-pay. Very few Family Physicians or internists actually use this code, because the pay is low and the administrative hassle is not trivial. The patient died, probably guided by an advance directive written in part because of the extra time and attention devoted to her complex care needs, which means there was likely an ER visit or two, and/or an ICU admission or two, that did not happen. But a Chronic Care Management bill was submitted automatically after she died (probably around $32). The mistake was caught and reported.
In the same practice, the physician had two patients named Maria Garcia. One of the patients died. The living patient saw the doctor in the clinic soon thereafter and the bill was generated for the wrong Maria Garcia, for say $72.
In its constant vigilance to weed out fraud and abuse, the Medicare computers flagged this doctor for submitting bills on dead patients. A clear case of fraud, right? The doctor got a notice in the mail that he was now tossed off the Medicare rolls. He could not bill Medicare for any services.
The doctor went through the usual phone calls and CMS departments trying to get this matter resolved, but to no avail. The small town he worked in now had one less doctor to provide care for elderly patients, one less doctor to cover the ER, one less doctor to care for sick patients in the hospital.
The doctor eventually had to hire D.C. lawyers — $25,000 retainer up front — and even lobbyists. The doctor ultimately spent $250,000 to be restored so he could continue to care for the elderly in his rural American town.
So in the future, when an old grizzled doctor says something like “Medicare sucks,” this is but one example of what he’s talking about.
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