Ongoing Life

Life is supposed to get easier as you get older?

I always thought so, but it has become such a nightmare that I no longer have time to go to Curves, to exercise on a daily basis, and even to wash my hair!

It is crazy how time consuming a Medicare Audit of 100 patients takes when you are already doing a fulltime job at work.

I am becoming best friends with some Medicare employees, and am slowing figuring out the system. I've learned that the Customer Service of the Enrollment Department is down five buildings from the Enrollment Dept. I've learned that I can talk to a Pat Miller from Customer Service, only to call back five minutes later and be told the next Customer Service doesn't know anyone by the name of Pat Miller because the Customer Service department is so big they don't even know each other. I've learned that the Enrollment Dept doesn't speak to the Education Dept, or the Auditing Dept and that each department could be in another state (either IndianapolisIndiana, Cincinnati Ohio or Louisville Kentucky). Depending upon which one you call, you get a different answer from all of them. They are mostly run by RN's who have a broad knowledge of medicine, but are not experts in any field over which they manage. There is no Chiropractor on the board that oversees the Audits.

I have learned that Sonja Racke and Bev are wonderful in the Education Department and that if every department had as excellent employees as they are, Medicare would be run more efficiently.

I've been very distraught with the employees in the Enrollment Department and in the Auditing Department. Before we got audited, we lost one of our Associates and hired another. We were running under a sole proprietorship, so changed over to a Corporation to allow Associates to become part of the business in the future. That meant we needed to Enroll in Medicare all over again for a new medicare number under the new Tax ID.

The Enrollment department is illusive and you can't ever talk to someone from that department and so they have sent back my paperwork about three times and I'm still not enrolled after 4 months of working with them, since last April 2007, even though I've always sent them the requested information by the next day. If you have a problem, you just can't reach the right person to help you fix it.

And then in the midst of all these major office changes, we got Audited by Medicare for dates going back to 2005.

It is always a guessing game as to whether you actually will get paid for your services. And even if Medicare does decide to pay the Doctor, they can turn around three years later and Audit you and take back money they have paid you. So, now just to make sure we don't get raped of the money we have earned, we are telling our patients that if they can't document an injury, even if they can't straighten up their back to walk and are using walkers because of the pain they are in, Medicare considers them a Maintenance patient. Since Medicare doesn't pay Maintenance, the patient will have to cover their own visits. Before this audit, if we could document spasms and nerve pain, we documented our patients as needing active care. All of us know that as our bodies get older and our disks degenerate we will at times have tiny little ruptures that hurt like the dickens and take time to heal. They can occur as we bend over to pick up something from the ground, and they most often do not occur as a result of an injury.

The sad fact about all of this is that our Medicare patients are no longer coming in when they hurt, but are waiting for a bigger accident to happen, and so they now come in with disks that are ruptured because they didn't come in when they first began to hurt. So then it takes more treatments to get them back to a Maintenance level. In the end, Medicare pays more than they would have if they paid for a patient hurting without an exact injury.

I've actually begun to take pictures of the patient's x-rays whose spines have severe degeneration and scoliosis to prove to Medicare that a patient can suffer a lot of pain without an injury. Chiropractic can prevent scoliosis from getting worse, but not if the patient waits to get a treatment until he is injured.

Chiropractic can heal a ruptured disk, but our experience is that it takes at least a year, and that is still a lot cheaper than the surgery, and you aren't ever guaranteed with surgery that the degeneration won't come back. When Dr Miller had a ruptured L-3 disk, the Orthopedic doctor gave him a choice of not having surgery and getting regular Chiropractic care for two years. He was hurting so much, he couldn't work. He told him that whether he does Chiropractor care for two years or does surgery now, the results will be the same in two years. He said "if you can't urinate, we will go ahead and do the surgery." Well, you know, all Dr Miller did was lunge at the racquetball when L3 ruptured. It never takes much when our bodies are about to break down.

So, Life has not been much fun for the summer of 2007. I was hoping to have all of this finished by my family vacation with my children and grandchildren the first week in September, but we still are not finished with the Auditing department, nor are we enrolled with Medicare yet for the new Tax ID. We are holding claims from May through current until we hear from the Enrollment department. They still have us under our old number and our old federal tax Id which is no longer official by the IRS. Oh well....

Our Medicare files are becoming impeccable......and our Medicare patients are becoming more and more distraught. Some good has got to be found in all of this mess........

I always thought Medicare fraud was when a Physician really didn't see the patient or saw a patient that shouldnt' have been seen, but sent a bill to Medicare for services he didn't give the patient. Now I know that half of Medicare fraud is really not fraudalent on the part of the Physician, but Medicare employees are using fraudalent measures to get back money to pay their employees in the Auditing department.

Carol