Hello again colleagues and guests,
I hope some of the guests are Medicare recipients who will be the ones
getting hammered by the PECOS. Come to think of it, that includes me. My
how time flies. Heres the deal.
Medicare acknowledges that all of the required edits for PECOS might not
be in place by the July 6, 2010 deadline. However, Medicare (CMS) also
states that they reserve the right to go back and reprocess claims. In
short, if you provide service for a physician who is later deemed to be
a Medicare ineligible physician, your office will take the financial hit
for the services rendered. This is just one more example of the “stupid”
decisions and regulations that the federal government is handing down.
Now, in addition to this BS, yes BS, Brightree just announced that they
have removed 129,000 physicians from their approved list, even though
they were deemed approved previously. Thankfully, Brightree is going to
make the edit changes for us. Had they not, we would have had to start
over with out list of approved Medicare physicians.
And finally, if you as a Medicare patient visit a physician who is not a
Medicare provider, that physician will not be able to write a
prescription for you or make a referral for other services, such as
laboratory tests, specialty physicians, etc. We have one patient who
goes to a physician who takes cash only. His office does not accept any
insurance, period. This physician is also the primary physician in a
rural area that keeps fees down for patients by not accepting insurance,
Medicare, etc. This patient will now have to find a new physician,
because the current one is telling Medicare and the insurance companies
to stick-it. But if the patient lands in the hospital, that physician
will not be able to provide services for the patient, provided tests or
referrals are required.
For now, these issues are not immediate problems, but come July 6, 2010
and thereafter, the you-know-what will hit the fan for many of us
Wil Haines, CPO
MaxCare Bionics
