Aetna Medicare Advantage Made a Ridiculous Chart Request. You Won’t Believe How I Complied!
I have written previously on this blog about the burden of Medicare Advantage plans demanding biannual chart copy requests on all of their patients. Typically, the period is for the last two years. It is a huge hardship, but, as the technical person in our small practice, I handle it. I either upload them to the portal or burn the charts to one or two CD’s. It takes quite a few hours, but… it is what it is….
If you have not read my previous post on this topic about Medicare Advantage chart requests, please review it.
Anyway, something new and terrible arrived at the beginning of this year. As we were all struggling with staff shortages from the latest Covid variant, AETNA issued a demand for the PAST SEVEN YEARS of medical records for 60 patients. This was far in excess of the usual one or two years of chart notes, hospital records, labs, consultant notes, etc. After seven years, many of these charts were huge. When these were on paper, seven years of records for just one patient would stand a few feet tall.
I called the company to verify: “Seven years? Really? Do you grasp the magnitude?” The answer: “Yes, really.”
I did wonder if this was a request over something more serious and I was assured by the phone person that it was just the usual Medicare Advantage biannual chart request.
I fretted and fumed. I complained to anyone that would listen. Then I had a brainstorm.
All of our pre-EMR paper charts have been scanned and maintained on easily accessible redundant storage media. Those are not hard to collect.
Our EMR charts can be output to PDF files as needed. This is when I discovered a super cool option for outputting the chart. Instead of one patient having one neat PDF file for the entire chart, I found an option that let me output EVERY SINGLE PAGE as a SEPARATE PDF file. That means one chart could have thousands of separate PDF files that required the reviewer to laboriously click through each separate PDF file to see any information.
So, the patient would have a directory folder and in the folder would be thousands of PDF files. Picture how Windows File Explorer would freeze and show the timer hourglass for eons every time you simply opened a folder. Then you have to roam through all of those files which simply have a time-stamp on them.
Wow! IMAGINE THE REVIEWER’S AGONY!!!
Then, I found a way to also convert each paper chart into something similar. I could turn a single PDF scan of 1500 pages into 1500 separate PDF files, each showing just one page!
Think about it. Seven years of sixty charts for complicated elderly patients with lots of consultant and hospital notes, as well. Literally many tens of thousands of pages transformed into many tens of thousands of small computer PDF files!
It is so diabolical! So brilliant!!!
Even without these “helpful modifications,” it was clear the total size of the chart request was going to be about TWENTY GIGS OF DATA!!!! That was totally out of my control! It was the nature of Aetna’s request. Even PDF files can get huge if you add a lot of images. Seven years of records times sixty patients equals a lot of data!
Certainly, this is nothing our internet connection can easily upload to a portal. Our internet connection is fast, but it is not fiber optic. Also, the portal limits file sizes.
So, I ordered some blank DVD’s from Amazon overnight (Not CD’s, but DVD’s). The next day, I started burning the data to many DVD disks in numbered, password protected volumes. It came out to 7 neat little DVD disks.
I also carefully kept a copy of all my hard work in a safe location so I could do it all over again when they claimed to have “lost the disks.” A letter accompanied the disks, describing my honest and diligent efforts to comply with their requests and current law so they could get extra Medicare money. For their convenience, each patient had its own convenient ZIP file, some containing tens of thousands of individual PDF files.
Over the years, our practice consultant frequently criticized my rapid responses to these requests. “Once they find out how quickly you respond, they are just going to keep demanding even more charts.” That may explain the crazy “seven year” requirement, which I had thought was just a typo that no one felt they had the authority to correct. We were probably a test case.
I never heard back. No one complained. As you can see, I tried to avoid any hardship because I consider myself a caring and compassionate physician….
Dr. Mussey, you troll like a pro. That much work (compliling, separating files, ordering/buying/burning DVDs, shipping DVDs, etc) is a ton of work to troll Aetna. I love that. It’s akin to paying your taxes with a wheelbarrow full of pennies or something. I used to troll insurance companies like that (and I still occasionally troll them on the rare interactions I have with them) BUT I gotta say: Brother it isn’t worth it, as satisfying as it surely is. DUMP insurance! The free market awaits! You’ll never code again.
Way to go to effff these people over. Make their lives miserable!
Awesome!
Brilliant!
I hope you use this technique with all the insurers requesting two years of records also.
That’s a good one. We just ignore them. If they want to come to office, we let them in. I have stacks of requests right now. They can throw me off their plans if they want. I don’t mind because I’m slowing down. I should have gotten off all Medicare disadvantage plans long ago.
I’m just curious. Do you need to get the patients authorization to release their medical records??
The law is very clear: Patient authorization is not part of the process for Medicare Advantage plans. Every request includes a copy of the applicable laws. Your health insurance is entitled to whatever medical information it decides it needs.
Absolutely brilliant !!
Of course you know that next year they will rewrite the rules so that you can’t do this. But I’m sure you’re working on a new gimmick that will set their brains on fire.
BRAVO !!
Brilliant!