Psychiatrists know all too well that dealing with insurance companies can be not only time consuming, but sometimes harrowing. Here’s a happy ending for one member’s frustrating tale.
Through its Practice Management HelpLine, staff of APA’s Office of Healthcare Systems and Financing (OHSF) frequently hear from members who are thinking about opting out of Medicare because they’re fearful about falling into legal jeopardy if they fail to follow all of Medicare’s complex rules. Generally our policy is to reassure these callers that if they code and document appropriately, they should not encounter any problems.
Nonetheless, the Centers for Medicare and Medicaid Services’ (CMS’s) rules can be extremely confusing, and when APA members do encounter problems, they often find it difficult to reach the level of authority within the Medicare system that has the ability to resolve their issue. When that happens, a good place to turn is APA’s HelpLine.
Earlier this year, an APA member in Alabama started receiving what he described as “mountains” of letters from Cahaba GBA, his Medicare administrative contractor. Each letter stated that he had been paid erroneously for a claim and was required to return the payment. His office manager called Cahaba’s customer service number and was eventually put in touch with a supervisor who explained there had been a computer glitch that led to the generation of the letters. She said that the company was unable to correct the problem at the moment, but told him to disregard any further dunning letters he received.
To his relief, he received a letter from Cahaba in April stating that 11 of the requests for repayment had been rescinded. Although a few repayment requests continued to trickle in, neither he nor his staff were concerned. Then, at the end of June, a letter came from Cahaba stating that the psychiatrist owed more than $23,000 (which included $808.60 in accrued interest) and that his case was going to be turned over to the Department of Treasury for collection. The first week of July brought another letter with the same information, but for a far lesser sum—$1,148.11. The psychiatrist called the HelpLine for assistance and faxed the letters he had received. He was concerned about how having to pay this chunk of money would affect his practice.
Because the HelpLine maintains working relationships with most Medicare contractors, we were able to contact Cahaba’s medical director and send him a summary of what had occurred. Within two hours, the situation was resolved, and later that day the psychiatrist received an e-mail from Cahaba that the two most recent letters had been “incorrect,” no money would be recouped, and no referral for recoupment would be made to the Department of Treasury.
We have heard from members in similar cases who immediately hired an attorney (at great expense) to seek a resolution on their behalf. Certainly that is an option, and indeed sometimes legal assistance is necessary, but the HelpLine is often able to serve successfully as the first line of defense. ■
Ellen Jaffe is a Medicare specialist APA’s Office of Healthcare Systems and Financing.
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