It's been a month...

We've been open for a whole month now... and it's been mostly good. Many many of our old patients have followed us to our new home, and we've gotten a few brand new ones as well. Our motto is "a new way to practice old fashioned care." Because we are a micropractice -- keeping low overhead with a tiny staff and a no-frills office -- we can afford to spend 30 minutes with the average patient. We don't need to see 25 patients a day, nor do we want to. Oxbow, our amazing EMR (electronic medical record) system, keeps our charting time down, reminds us of important health maintenance for our patients, sends out prescriptions and lab orders. We use an online scheduling and billing system that's free and easy to use so we don't have to pay a full-time billing or front office staff.  Lindy and Robyn, our nurses, do an incredible job of taking the stacks of new patient records and digitizing them so we can use them in the EMR. Their high-tech expertise is a wonderful complement to the caring attitude they always have towards our patients.  

Dr. Nelson is new to the area. She had been practicing in Cumberland in a family practice center, but was eager to try something new. She especially loves seeing children, and is looking for ways to expand our pediatric base. 

Dr. Hahn is happy to be back with his former patients. His forte seems to be the older patient. He loves hearing their stories, especially those involving secret fishing spots! 

The only problem we've been having is with insurance companies. We decided to embark on this adventure over the holidays last year. We found some support, especially through a local health system, who, among other extremely helpful things, offered us a credentialing specialist to get our insurance participation going. This can be an especially daunting experience, since every insurance is different, and they all need endless documentation; if just one "i" is not dotted, or "t" crossed on an application, it can send a provider's credentialing back to square one. So the credentialing started probably in February. I started sending Dr. Hahn's documents to our angel Amanda, who in turn, would send me reams of documents to read and sign. We started receiving contracts in May. 

The average patient doesn't realize that every insurance company pays its participating providers something different. Some insurance companies are notoriously bad at payment fees as well as service, others are better. It was very interesting to us that none of the contracts we received included fee schedules! We were being asked, in essence, to sign a contract with no specific agreement on what we'd be paid for each type of office visit. We would call the company, which could often mean 2 or 3 hours on the phone just trying to figure out who was the right person to talk to about this. So we would get the fee schedule finally, and either sign the contract, or try to negotiate some of the more pitiful fee schedules.

Now that we have been open for a month, and it's been almost 7 months since we started the credentialing process, we are still not totally "on par" with several companies. We have signed the contracts, received information in the mail, etc., but still when our patients call and request the change of provider, it's like we don't even exist. This, I suppose, will just take time, to "load" our record into their Byzantine system.

I had some real fun yesterday. The day before, a representative of the West Virginia Medicaid system came into our office to try to explain how they worked. I have only so much patience for the absurdity of unneccesarily complex systems, so I started tuning her out until I heard her mention that there were 3 entities, not just 1, involved in WV Medicaid. It seems that if a patient has "UNICARE" following the date of birth on their card, we bill something called Unicare, rather than UNISYS, which is one of the other entities. And then there is something called PAAS. Now, I knew that Amanda had credentialed us with Unicare and UNISYS, but I didn't know anything about PAAS. I also didn't realize that Unicare administered WV Medicaid; I thought it was a totally private insurance company, and I figured that we probably had already seen some patients that participated in that program. So yesterday I got to work. I had to figure out if Unicare that we were participating with already was the one that ran WV Medicaid, or if we had just been par with some other private company that also had the same name. It took me 2 hours. I had a credentialing letter from a company named "Unicare" and when I went to their website mentioned in the letter, I saw that they had state-sponsored programs, one of which was West Virginia. But, when I called the number on the letter, the representative I talked to declared that she had never heard of the West Virginia program and that it must be some other Unicare. And, furthermore, she said that she couldn't find either of our doctors in her system! So, I called one of the phone numbers on a patient's Unicare card (from WV Medicaid), and was told that they, too, thought that this Unicare had absolutely nothing to do with the "commercial" Unicare, but that both providers were, yes, credentialed. I still thought they were wrong based on what I'd seen linked to their website. To make a long story short, I finally called another phone number from the patient's ID card, and finally finally finally found some happy-sounding woman who declared that, yes, you should file all Unicare claims under the Unicare billing number, including WV Medicaid, and Yes, allelujah! she has both doctors as credentialed providers in her system.

Sorry if that is so rambling. But this is the sort of thing I've been doing since we opened. I had pictured myself going in to the office for a few hours each day to follow up on claims, happily depositing checks, calling patients to remind them of their next-day appointments, helping Lindy and Robyn up front, and then going on about my day. But instead, I've been doing stuff like my previous paragraph. I'll have a letter from an insurance company acknowledging that our doctors are credentialed, but then when I call with a question, it's like the letter was mailed from Mars or, maybe I'm in some weird altered universe. I cannot imagine that this is the best way to run healthcare! Why does each insurance company have such different credentialing requirements? Why does it seem like they don't know what's going on within their own companies? Why are they so mysterious about what they're going to pay us? Why does it take 7 months to push some paper around? 

If there were one payer, it might take awhile to get credentialed. But then it would be done. As it is now, we will have to stay on top of what -- 11? insurance payers and their constantly changing policies. It's our responsibility to read each of their bulletins on changes in how they're paying, and initiate changes in our procedures to keep up with it.  What other industry has this burden? We are responsible for people's lives. That should be our focus, not having to constantly read fine print, or risk not getting paid.