Tightening The Thumbscrews


Another thought-provoking article was just published in EP Monthly about how Medicare is cutting more payments to physicians. It will be interesting to see the unintended effects of Medicare’s decision.

Medicine is unique in that you can’t just leave one job on Friday and start another job at another hospital on Monday. Before you can get privileges to work in a hospital, you have to fill out a staff application, have all your references checked, go through committees, have the committees sign off on your application. Then you get your privileges. You also have to apply for all the new billing numbers, get insurance companies to change to your new location, yada yada yada.

All of this takes time. Sometimes a lot of time.

In emergency medicine, you used to be able to begin working at a new hospital a soon as you got your staff privileges – even if your billing paperwork had not been approved. You’d see patients, then hold your charges until you get your insurance approvals, then bill the insurance companies for all of the work you performed.

Medicare is now changing the rules.

According to the new Medicare Retroactive Billing Policy, Medicare will no longer pay for retroactive charges.

This policy doesn’t even make sense.

Provider payments are held up until Medicare gets around to approving the providers’ applications.

Think this policy is going to make Medicare work faster at processing applications?


  1. Oh geez! Not like Medicare is always a timely payor to begin with!

    Not to metion how slow the CMS offices are when it comes to provider enrollments.

  2. According to CMS, a zero sum game means the doctor receives zero. Why should anyone participate in this obvious ponzi scheme?

  3. Sleepyjosh — you’re completely ignorant. CMS is by far the fastest payer.

    Whitecoat — This is not actually a big deal. Yes, it means there’s a hard deadline and no forgiveness, which is why ACEP is working on getting CMS to rescind this rule (one of many value-added services that ACEP performs). But, as you mention, there is a significant lag time between applying for hospital credentials and being approved. That lag time tends to be longer — in some cases much longer — than the approval time for medicare. The net effect of this is that our new hires must have their medicare apps complete and submitted prior to or at least contemporaneous with the hospital apps. We’ve done this many times (I’ve hired and credentialled about 25 docs in the last several years) and it’s not been a problem. (Maybe Dave Packo doesn’t have as well-oiled a process at EMP?)

    The take-home here is that the medicare app has just become the most important part of paperwork to get in and approved. Don’t Fuck It Up. The loss of that retroactive window is worrisome, and hopefully will be restored.

    And ERP, you’re right — we don’t let anybody start working until their paperwork is all in line.

    • Shadowfax–In our practice (a part B provider–not using EFT), Medicare tends to be on the slower side in approving/paying claims. Granted, there’s also a commercial insurer or two who is also slow.

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