Chart Requests: Medicare Advantage Allows Doctors to be Accomplices!
Medicare Advantage plans have many problems. One of them is the companies that demand you, the physician, supply them with the past two years of patient records for everyone. To quote the language of one such plan, here is the explanation:
Why are you reviewing the patients’ charts? All Medicare Advantage organizations must submit complete and accurate data to the Centers for Medicare & Medicaid Services. The review helps us confirm suspected chronic conditions that haven’t been submitted on a claim for the service date range in question. Conditions actively being treated or those that may affect the patient’s treatment should be reported on a claim at least once a year. These reviews also help identify patients who may benefit from our care and disease management programs.
TRANSLATION: The records are used to document increased illness severity so the company can get more money from Medicare. The company may try to justify the increased expenses by having a nurse make an occasional brief phone call to the patient, which does little more than confuse the doctor’s care plan. It’s an incredible scam and the government is only slowly noticing the problem.
Do I have to comply with chart review requests? If you are a contracted provider, you must participate in the chart review and provide the charts requested.
TRANSLATION: You, the doctor, are REQUIRED BY LAW to provide the records FREE OF CHARGE. It’s painful and expensive for any office seeing lots of Medicare Advantage patients. These demands come every six months, without fail, from every such plan.
That’s right. You, the doctor, are now an unpaid accomplice to insurances grabbing more taxpayer money. How do you mechanically do this task? The companies helpfully offer several options for sending the records, which often are many thousands of pages:
- You can print them out and mail them, at your expense. Think about that for a minute. Many thousands of pages means paper costs and a very heavy package to send at your expense.
- You can FAX the records to a “convenient fax line.” Think about that, too. Faxes do not scan quickly. Multiply that by many thousands. Your fax line will be jammed for days, months or even years! Nope, this is not even close to a possible option.
- You can use the online convenient portal. In all fairness, these have improved somewhat. Often, however, the size of the PDF files are still so large they exceed the capacity of their system.
- A representative of the company will come in and access the records. Hmmmm…. Just what you want… Somebody occupying office space you don’t have, logging into your computer system, gaining access to your EMR, probably inserting a USB drive with all sorts of viruses.
A number of years ago, one of the companies visited us to remind us we needed to forward these records. I had already sent the records, but the company lost them, which is a very common event (make a backup disk). The perky representative pulled out a USB drive and offered to quickly download the charts from our EMR.
She lurched towards one of our computers without even asking.
I told her to “FREEZE! DROP THE USB DRIVE AND STEP BACK AWAY FROM THE COMPUTER WITH YOUR HANDS HELD HIGH!!!”Actually, it wasn’t that dramatic but I did tell her to immediately leave and never think of putting a USB drive into someone else’s computer.
At some point, you just have to say “No,” or the abuse will continue.
Pick the worst abuser, notify your patients that you’ll be dropping that plan in six months and move forward.
As you’ve written, there are more than enough patients needing doctors so that your practice won’t suffer.
If you continue to contract with shitty plans, nothing will change.
Yup and I think I mentioned before that the AAFP wanted something like $900.00+ so I could be listed as a “retired” member in good standing. I declined and wouldn’t mind being labelled as a “pi$$ed” off member in bad standing!
Glad I retired 2 and a half years ago before “these” chart requirements were fully ramped up. Talking about screwing up primary care. This might be the death knell to it.
Yet another example of the complete and total failure of the primary care medical societies to represent the interests of their dues-paying members.