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.

It is time to start blogging again.

If I don't start blogging, I'm going to end up at the Humana headquarters and get arrested.

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.

Scleroderma Sucks!

Our friend Tori Anderson is one in a million. She has a beautiful voice that echoes the beautiful person that she is. We've enjoyed her musical journey with Possum Holler for many years. She's gorgeous and talented. Unfortunately, she is also 1 in 300,000 of people who have been diagnosed with Scleroderma. This disease has no known cause, and no known cure.

We've walked with Tori for the past two years in her Walk With Tori, and we'll be doing it again this year, on September 8th at Doub's Woods Park in Hagerstown. The past two walks have generated $78,000 towards research at The Scleroderma Center at University of Pittsburgh Medical Center. It's been so inspiring seeing the hundreds of people who turn out for this event, including Dr. Thomas Medsger and members of his research team at UPMC.

Please join us this year. Walk, donate money, donate a silent auction item. Get a team together and walk together. Bring your checkbook -- you'll be amazed at the wide variety of quality silent auction items that grace the tables.

For more information, you can email tori@wayz.com or walkwithtori@yahoo.com, or you can call Tori at 717-597-9200. Mail donations to PO Box 327, Hancock MD 21750; checks should be made out to "Walk with Tori." Join the Facebook page for breaking information, or to network with other walkers.
See you there!

Our staff is AWESOME!

Yesterday was a challenging day at our Hancock office. Dr Hahn needed to take the day off to attend to some business and I was working at home (not that my presence would've made any difference!) What happened yesterday in his absence made me so proud of our staff for going WAY over and beyond the call of duty yesterday. I can't divulge too many details here in order to honor patient privacy, but trust me: amazing staff+technology+ compassion saved at least 2 lives yesterday. Amber Morrow is an amazing Nurse Practitioner with maturity and knowledge well above the norm, let alone one of her relatively young age. Lindy, as always, was the voice of calm and the mind of reason. We really need to think of a new name for what it is that she does, as she continues to raise the bar. The title "Medical Assistant" just doesn't do her skills, knowledge, and high standards justice. And thanks to Tonya for doing her part in holding down the fort. It's nice to know that Dr. Hahn can take a day off and have a staff that he can depend on, and THEN some. Way to go, everyone! 

This week's menu - Focus: No meat!

As I mentioned in our recent Facebook post, we were inspired this week to revisit our almost-meatless days by our Nurse Practitioner Amber Morrow. We all had dinner at Tari's last night, where they usually have a nice selection of meatless dinners, and she and Willa (our 18-year old) both chose one of those. I got the beef tips, but theirs actually looked tastier (although the beef tips were very good...) When our family moved to Berkeley Springs 13 years ago, we were strict vegetarians. However, after about 3 years of living here, where being vegetarian meant you had to pick the bacon out of the green beans, or deal with the fact that your black bean soup had lard in it, combined with fact that our favorite hangout, The Troubadour Lounge, was purported to have the best steak in the universe (and it does), we were eating meat fairly regularly. So this week we're going to try toning down the meat, and increasing the veggies. You don't have to be a nutritionist to know that more vegetables and less meat is better for your health: the vegetables on your plate should take up at least 1/2 the space, with the other half divided equally between lean protein and whole grains. Here is this week's menu, with links to the recipes.

I found most of these recipes on two of my favorite food blogs, Smitten Kitchen and Serious Eats. If you're ever feeling bored with menu planning, I challenge you to spend 15 minutes on either one of these blogs and not be drooling with anticipation, inspiration, and a shopping list in hand.

Chana masala

Indian spiced cauliflower and potatoes

Jasmine basmati rice (you can buy this at Martin's grocery store, or any grocery store with a good selection)

Store-bought naan bread (even our poor old Food Lion usually carries this)

Huevos rancheros

Herbed green beans (really, just steamed green beans with some garlic- and rosemary infused olive oil dressing)

Pasta with garlic and broccoli 

This is easy: 

1. Start your pasta water boiling; steam 1 large clump of broccoli per person until bright green but not limp 
2. In a large saute pan, saute about 3-4 cloves (or more if you like) of very very thinly sliced FRESH garlic -- not that junk in a jar -- in about 4 tablespoons of good olive oil. Shake in a little dried chili pepper
3. Cook the pasta
4. Toss the cooked broccoli with the sauteed garlic until coated. Add more olive oil if desired, and salt and pepper to taste. If you like parmesan cheese, sprinkle on some freshly grated cheese. Serve with some good French or Italian bread.

Vidalia onion soup with croutons

Green salad

Pan fried tofu with dark sweet sesame sauce

Asparagus sautéed in (purchased) black bean sauce

Either rice or udon noodles

You'll notice that none of these recipes are American. Sadly, there is not a lot of traditional American food that's vegetarian. In Asian countries, meat is often more of a condiment. In India, beef is forbidden to the Hindus, and other meat can be scarce. Anyway, it's fun to cook with different ingredients, and combine old ones in interesting new ways. If you're stuck in a food rut, try some of these!