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03/06/2018 Amy Schunemeyer, DPM
The Importance of Challenging Medicare
So, I noticed that my Medicare allowable was less than the Novitas website posted allowables for my claims coming back for 2018. There is a Novitas mistake that the were following the WRONG fee schedule up t0 2/23/18 and they are working on resubmitting corrected claims. This is one problem fixed.
And, I notice that the increased payment adjustment is in the form of a positive ($xx.xx) adjustment on our EMRs. This is a quite a software accounting nightmare (How are others handling this) and these are a few of my questions because I am NOT receiving increased payment from the many, many, many Medicare Advantage plans. Do they have to pay me more too?? Or are they somehow finding a way to squirm out of it?
I finally found my QRUR for 2016; and was very pleased and shocked that I performed as well as I did; High quality and Average Cost. I am actually GETTING MORE money from CMS!I was MORE shocked at how many physicians are losing there rightful income. I don't know if you care or have even bothered to look at the stats, but I'm about to give them to you.
1) I am 1 of only 20,000 clinicians receiving positive payment. Why only 20,000? This is crazy! There are 1,151,000 clinicians participating with Medicare. This is only 1.8% of CMS docs. How am I this extraordinary? (And I'm definitely NOT, BTW). 65% reported something - so they DIDN'T get a negative adjustment; and 26% got the automatic % lost because they chose to blow CMS off.
2) I would LOVE to see how many of the 20,000 are DPM. I have a large wager that it’s a nice chunk of the 20,000 docs.
3) If DPMs comprise a large number of those receiving positive payment, then we as a profession NEED to use this to our advantage! That is toward the ever failing attempt to gain physician status with Title XIX (19) Medicaid.
Also, I have been slowly but successfully fighting with Medicare Advantage plans (WellCare; BlueAdvantage; Peoples; Vantage to name a few) regarding the ability of a DPM to dispense and receive reimbursement for diabetic shoes and wound care supplies.
I have NOT seen any other DPMs reporting these issues (Or I just may be looking in the wrong place). I find that my fellow DPMs find it too difficult to fight these policies when they don’t get paid. I see it as a slippery slope to losing the privileges that we have.
If you have answers to any of these, please do tell; otherwise I guess this is FYI and just my opinion
Amy Schunemeyer, DPM, New Iberia, LA
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