Medicare Morass

The government is killing me. In their much maligned efforts to control costs they end up accomplishing just the opposite. I spent the majority of my day today sorting through the morass of developing a coding plan for a new procedure.

Part of the problem is Medicare (CMS) can't call an ace an ace and a spade a spade. They hire fiscal intermediaries (FI), usually insurance companies, who develop there own local medical review policy (lmrp) for a region of the country. For the most part, the individuals that develop these policies have no clue about the procedures they're making decisions on, especially in Radiation Oncology.

So for one part of the country you can charge for this procedure but, maybe not in another part of the country. I've contacted our FI for guidance on procedures and they don't even have an LMRP for the procedures I was inquiring! Let alone what we can charge for it and what we can't.

Its so bad a cottage industry has sprouted to just try to interpret the rules for us. For a small fee no doubt. What happens then is that this consultant says you can charge for this, another says no, and chaos abounds in the world of cancer coding. In addition, if you do charge for a procedure the documentation required to prove you did indeed do the charges associated with it is ludicrous. Our charts and have doubled in size in the last five years. Thus, increasing our paper, charts, and storage costs.

Adding insult to injury, there are these insane code edits( regulations)that if you perform x on this day you cannot charge y or z unless it is on another day. Even if the charges are totally unrelated. Huh?

Thus it is easy to see that it is a very grey area on what can be charged and what cannot. What I've described here is only the tip of the iceberg. If only Medicare could state in black and white you can charge x,y, & z but not n for this procedure the costs of healthcare would instantly decrease. And my productivity would inversely increase. Not to mention the positive effects on my frustration levels