Medicare Questiongreenspun.com : LUSENET : TimeBomb 2000 (Y2000) : One Thread
I'm looking for the article about Medicare not going to except claims after April 4th if clinics or hospitals are not compliant.
Do you think this will be handled quietly internally? Could a clinic or hospital thats not compliant turn down Grandma,Grandpa and the disabled? Figuring they won't get paid from Medicare until they become compliant.
What about insurance companys? There are people who have other insurance which would get billed before Medicare. Are they in turn forcing insurance companys to also except compliant clinics and hospitals? Who gets the balance of the bill? Grandma?
Any information on this would be appreciated.
-- maji (majiWI@yahoo.com), March 13, 1999
maji, if any hospitals were to lose Medicare funds they would be toast within days. They wouldn't be able to make the next payroll without it. The average big city hospital receives multiple 7 digit checks from Medicare Part A weekly.
-- MoVe Immediate (MVI@yepimhere.com), March 13, 1999.
>Maji, Moveimmediate is correct in that should a major hospital become inelgible for Medicare funds they wouldn't last past the next payroll. That may be an exaggeration but not by much. Locally, Greenville Hospital System has about 9.5 million in surplus....their payroll runs about 1.6 million per week. No funds coming in---no hospital system. The claimpaying portion of Medicare (HCFA) is definitely noncompliant at this stageof the game. (See GAO report the latter part of February--there's a thread this site). I doubt VERY seriously that any insurance company or Federal Supplementary Agency will refuse a hospital or clinic payment for noncompliance until 1/1/2000 (at which time the insurance agency or Federal payment plan will also be noncompliant too and can't pay??)
I own and operate a Home Health Agency and we have seen nothing from any insurance company or HCFA to indicate possible nonpayment. Actually, they have yet to even ask if we are compliant. (We are, but that's a whole 'nother story). I am far more worried about THEM than they are about me. I will say this....ANY time anyone utilizes health services, the recipient of those services is FULLY responsible for the ENTIRE bill. There are only two exceptions: 1. Client is fully covered by Medicaid (state) or; 2. Client is fully indemnified by a HMO.
The acceptance of insurance or Medicare by a health organization in no way releases the obligation of the patient to pay except in the above two instances.
-- Lobo (Hiding@woods.com), March 13, 1999.
I am employed by a large health care provider which operates in 50 states and offshore. We have been notified by HCFA that all claims filed effective April 1999 must be in the year 2000 format. Our medicare claims are filed electronically through an intermediary; in our case, BCBS. Our intermediary has assured us they are ready to accept claims in year 2000 format and our own systems are to be updated in midmarch (in beta testing right now at one of the regional business offices).
All healthcare providers who are contracted with medicare must accept medicare insured patients unless they cancel their contract with medicare and are no longer medicare providers.
Cancelling medicare contracts will not be an option for most healthcare providers and yes, problems in getting paid for filed claims will be handled internally for as long as the organization can carry the losses.
That being said, it is interesting to note that our organization is currently carrying 3 months of unpaid medicare claims. December claims were not filed until the latter part of Jan. upon notification from our intermediary that there were "problems". Whose?....not clarified. Effective Jan 1999, filing requirements for our industry involved some cpt code changes, itemization of codes and notification that those claims will be paid based on medicare provider fees instead of an "interim" fee. To date, we are informed that the Dec claims are being processed, but HCFA is having "problems" with the Jan and Feb claims due to the new codes and payment guidelines. March claims will be filed in April in the 2000 format.
There is no sense of panic from our organization and we will continue to work with HCFA and our intermediary. That said....our company is able to absorb these delays for a long time. Smaller healthcare providers will not be able to do so.
I don't want to leave this post with a negative spin, maji. Those in the healthcare industry are, by and large, in the field to provide healthcare and will continue to maintain that focus. I don't know how this issue with the insurance companies will be resolved, but I feel confident that medical care will continue. As you can see by my examples of 3 months unpaid medicare claims, medicare has always had payment issues not connected with y2k and our organization has never yet had to contact a medicare patient to intervene. We are very sensitive and protective of our medicare patients' needs. If an organization as large as ours and BCBS are working to resolve these issues with HCFA, what in the world would a lone medicare insured person be able to do that we are not? Any services provided under medicare contract must be paid for by medicare. Maji, as alway, when seeking medical care, just verify the medical provider is a contracted medicare provider and those medical services are a covered benefit. Any services or equipment provided that are not covered or "might" not be covered by medicare must be detailed in writing and signed by the patient to verify notification. This written and signed notification of non-covered benefits must be in the patient file. Without this, the medicare provider cannot turn around and bill the patient for services or equipment not covered by medicare.
I realize this is a long post, but trying to explain medicare is not a simple task. Please make sure you have a medicare benefit handbook and educate yourself on patient rights. This is important information for you at any time, not just y2k, as not all medicare providers are aware of or adhere to the legalities of their contracts.
I hope you find some of this information reassuring or at least helpful......and haven't hurt yourself falling asleep on your keyboard!
-- susan (email@example.com), March 14, 1999.
This is the link to answer your specific question regarding the deadline (April 5, 1999) established by HCFA for submitting Y2K ready claims. http://www.hcfa.gov/y2k/mcarspec.htm Hope it works for you.
In searching for the link, I came across some interesting info in another link for New Mexico physicians. Because of required y2k testing, HCFA is unable to make necessary changes to process claims reflecting new codes..... and they go on to list those codes. It also states that claims submitted prior to April 1, 1999, should continue to use the "old" approved codes prior to the changes effective Jan 1, 1999. This sounds like an answer for our unpaid Jan and Feb claims, although not a solution. I'll take this info into work tomorrow and start it on its way "up the chain".
-- susan (firstname.lastname@example.org), March 14, 1999.
Susan, thank you. You said it better than I did. I did want to point out to maji that all insurance assignments, private or medicare, are a favor to the client by the healthcare provider. A number of MD offices now charge for private insurance filing. Hospitals and MD offices will be very quick to point out that should the private insurance not pay for whatever eaon, they will bill the patient. Medicare is a little different situation as most providers EXPECT a severe delay. We have run as long as 180 days for a claim to be paid. You are correct on the y2000 format needing to be used 4/4 but that doesn't mean the provider has to be y2k compliant, just change the submission format.
Thanks, I hadn't seen the change on the acceptance of the format. I'll follow up on that tomorrow.
-- Lobo (Hiding@woods.com), March 14, 1999.
Susan, is your hospital under PIP. If so, what losses are you incurring? If not, what deficiencies prohit you from qualifying?
-- MoVe Immediate (MVI@yepimhere.com), March 14, 1999.
Thank-you for all the information on this issue. You all have been very helpful.
Susan-The web page worked--glad you had it--I was starting to question if I had read an article like that.
-- maji (majiWI@yahoo.com), March 14, 1999.
maji and Lobo....you're welcome
MoVe....didn't mean to mislead you. Our facilities are not hospitals, but made up of a mix of diagnostic centers, outpatient surgicenters and in/out patient physical therapy clinics. We have several hundred across the US and all are medicare part A certified. Medicare is not a "loss" for us as a corporation, but not profitable. There has been discussion to drop our provider status, but with the new PT cap and reimbursement rates, a decision has been deferred. The feeling is per visit reimbursement will rise, but for the patient, news is not good...number of visits will decrease. Profitability per region is determined by patient mix, and marketing is very agressive to obtain the "correct" mix.
I enjoy reading this forum everyday and wish to thank all the active forum members. I have benefitted greatly from your preparation information and valuable links. I have little to contribute from Hawaii. It is all happy face news and awareness is increasing, but seems to be more word of mouth, local grapevine. I have discovered many people who are preparing and that is encouraging. One very disturbing bit of news discovered tacked on the end of an article relating to an audit of the Hawaii Health System Corp, dated Feb 25th in the Maui News was a statement the corp administrators asked lawmakers for $8 mil emergency funding for the current fiscal year. $3 mil to pay workers' comp claims and $5 mil for making the community hospitals' computer systems Y2K compliant. I checked the state Y2k page and sure enough they listed 13 systems, put 13 systems in the "started" column, -0- sytems in the "remediation Testing/Finished" column and left totally blank all other columns that detail "Est. Hours", "Hrs. Used", "Hrs. Remaining".
This is terrible for the outer islands...Oahu has a couple of private hospitals as alternatives, but the outer islands are dependent on the state hospitals, Maui, for example has one hospital (state).
Sorry, just sounding off...I realize Hawaii is very remote and the majority of the forum will find little benefit in this info.
Again, I wish to say thank you (mahalo).
-- susan (email@example.com), March 15, 1999.
At least your weather is good and you won't freeze.
-- Lobo (Hiding@woods.com), March 16, 1999.
Oh, and the second reason I do not post is the couple of times I have, someone always likes to point out that at least the weather is warm and I won't freeze....sigh.
But, eh...no need worry, Lobo, I still have much aloha for you. :)
-- susan (firstname.lastname@example.org), March 16, 1999.