We love our patients. We really do. We do all kinds of things other practices don't. Our patients will never wait more than 15 minutes in the waiting room. We always see sick patients on the same day they call. We demand our diagnostic offices get our patients same-day tests if we feel the matter is urgent. Our staff stays on the phone for hours trying to get preauthorizations. We visit patients at home. We give people who really can't afford their healthcare a break when we can.We save medical samples for those who need them. Birthday cakes for our elderly patients.....and I think they love us too.
That's why it's so hard when an insurer - a company we PAY to take care of us - is so ridiculous, so obsessed with denying claims whenever possible.
We have been doing depression screenings for years and not billed for them. Now our office is looking at incentive programs, and things we haven't been billing for and should've been. One of those is the depression screening, a simple question and answer form to assess a patient's mental and emotional well being. The other screening is alcohol screening to make sure patients aren't abusing alcohol. Medicare is paying providers to screen for these two things at about $18 each. It doesn't sound like a lot, but when you have 800 patients over 65, you're talking about $30,000. That would be a nice bonus for our staff. The nice thing is, when done with a regular office visit, there is no co-pay for the patient.
We started billing for the screenings in December. Medicare has paid them without a hitch. However, Humana, a large Medicare Advantage insurer, has not paid.
I needed to find out why; was it a coding issue? or what? Usually MA plans do things pretty much the way Medicare does, although they are permitted to have different rules.
I started out by calling the provider service line on the back of a patient's card. I was on hold for 45 minutes, and when answered, was told that I was talking to the Benefits department, not the Claims (there was no prompt for "Claims" on the phone message). I was told I'd be transferred to Claims; I sat on hold again for another 30 minutes, and was told - guess what! I was still in the Benefits department. I was a bit fed up by this time as you might imagine. I sat on hold for another 20 minutes, and got a representative who supposedly could help me.
She hemmed and hawed a bit, rattled on about the services being "bundled," something about "place of service," blah blah blah, and then said that I'd have to send in medical records for every patient who was having a screening billed.
I was stunned. What? I've never heard of this. This is a screening; it doesn't depend on medical necessity or anything else. It's something our insurers supposedly want us to do, and will give us "points" for doing, and possibly take away points for not doing. Why would Humana put this obstacle in our way, one that's so ridiculous and unnecessary?
I don't know. I've written an email to my Provider rep, as well as the board of directors for Humana. Maybe I'll actually get an answer. Not holding my breath.
