i hate medicare advantage plans especially humana

here we go again, Humana being picky picky picky about paying our claims.

Procedure code 99497 pays for up to 30 minutes of discussion and completion of the Advance Care document.

If the document is in the patient's record, it's pretty obvious that SOME time was spent. It's also obvious that it was less than 30 minutes due to the procedure code used.

The fact that Humana is applying this rule so stringently is discouraging us from offering this service to our Humana patients. 

Do you think a patient likes knowing a provider is timing their visit? Do you really think this leads to trust in a provider when a patient feels like they're taking up too much of the provider's time?

Wouldn't it be nice FOR A CHANGE that Humana respect our ability to give our patients the best care we can? Or is it down to minutes and seconds. Look, we could spend 29 minutes on the ACP and do a horrible job of it. And they'd pay us for it. So this is ridiculous.

CMS suggests that if an ACP takes less than 16 minutes, the provider should bill an E/M code instead. The problem with this is, the CPT for the ACP won't show that it was done and Humana will dock us for not doing them.

We are begging our patients to enroll in Medicare and get out of the for-profit insurance market. This is what happens when an insurer is worried about their CEO being able to afford a new yacht. I've never had an ACP denied because time wasn't documented by CMS. Documenting time does not contribute to a patient's wellness. 

Apparently Humana cares more about a ticking clock than they do knowing a patient is getting good care. It's that simple.

i am not crazy

 but i will be soon. Trying to get specific information for a payer can be extremely frustrating. For example, I need to send a corrected claim to Maryland Physicians Care.... just two little characters need to be deleted from the claim. According to the Claims Submission Instructions, I should use the Claim Resubmission Form. I have their Appeal form, but it specifically says not to use that form for resubmissions. Does it tell me how to submit a corrected claim? No, it does not. 

This gives me the distinct impression that Maryland Physicians Care doesn't care about my claim correction. They're just as happy - probably extremely so -- not to pay this claim.

I have done a search on their website. I have done a google search "Claim resubmission form Maryland physicians Care." The only form found is the Appeals form.

This is maddening and makes me want to throw something. And it's so typical. 

a peeve

 We accept so many different insurances, particularly when it comes to Medicare supplemental plans. Most Medicare patients have one. We get paid for visits first by Medicare, and then the claim goes on to the supplemental plan for payment. The payments are typically around $26.60, $22.18 -- not very much. Most of our payments come automatically, deposited to our bank account. So every month when it's time to reconcile the account, I go through and make sure all the deposits are in our system. Often I'll find one of these smaller payments missing. I'll find it, post it, and then apply it to the appropriate patient visits. Many of these come into our Practice Management system automatically also, which is nice. But now and then, it could take me literally hours to find one of these small payments. 

For example, here's what I see on my bank statement:

HCCLAIMPMT ABC PLATINUM                        26.60 

            

ABC Platinum isn't an insurer I've seen before. The amount shown, $26.60 isn't entered yet in my practice management software. So i have to go looking for it. There are about 8 "Payment sites" that various insurers use to upload their Explanation of benefits to accompany any payments they've made so we can download and apply each payment to the appropriate patient. In this case I go to one of those payment sites and find the payment. I usually know which one to use based on the name on the statement. However, after looking on each payment site, I haven't found it.

So today I've wasted about an hour trying to find it. I looked at each site, and after not finding it, I looked up the insurer online and called the phone number on the website. Of course, it's Friday and they close at 1:00. So I'm stuck with a meager $26.60 that I can't account for. It's no longer worth $26.60 to find it, but i have to so the patient's account will be up-to-date.

When I am Queen of the World, here's how this will happen instead:

All insurance payments will be held on ONE PAYMENT SITE. No matter the amount, $1 to $1M. No matter the insurer, Blue Cross Blue Shield or some podunky insurance like "ABC Platinum."

Long live the Queen.