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To: ottbmare

Thanks for that info.

According to your description though, the bureaucracy is paperwork heavy and byzantine to figure out, or else there would not be so many ‘code’ errors.

It would be good to get some true numbers on this though.


14 posted on 10/06/2009 9:48:33 AM PDT by Lorianne
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To: Lorianne
According to your description though, the bureaucracy is paperwork heavy and byzantine to figure out, or else there would not be so many ‘code’ errors.

Most claims are submitted electronically. Most doctors and all hospitals have personnel who are trained to submit the claims and have to fight with the system. They contact Medicare (CMS, the dread "Centers for Medicare and Medicaid Services" in Rockville, MD) through various Medicare intermediary companies that are supposed to assist them and actually handle the claims. Some of these intermediaries are horrible and others do a good job. It's monstrously frustrating because there is often no explanation for the reason a claim has been kicked back, and it times out while the office is trying to get an explanation of how to submit it correctly. That is, the final denial is because too much time has elapsed since the event/procdure took place. So the doctor doesn't even get paid the miserable sum Medicare is willing to pay him for his time. This is why some doctors don't want to accept Medicare patients.

The adminstrator of a large hospital told me during a conference call that this sort of problem had cost them $750000 in lost claims despite the fact that they had full time, dedicated staff doing nothing else except working on it. I have heard other, similar horror stories all over the US. It's a nightmare. And this is what we can anticipate if Obamacare goes through.

15 posted on 10/06/2009 10:09:15 AM PDT by ottbmare (I could agree with you, but then we'd both be wrong.)
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