Why Medicare Is Not The Enemy

As a billing service, I come in contact with many insurance plans on a daily basis. Every year, I have my favorites and the ones that I dread. In all the years I have been in this business, the latter change from year to year (I always have at least one on my hot list that gets my ire up); Medicare comes closer to being one of my favorites and I have had many discussions defending my opinion.

To be clear, it can be very frustrating to deal with the bureaucracy of Medicare, (translates as the government) but from a billing standpoint, this is not the case in my experience.

I find customer service very knowledgeable, the remits are easy to read with even denial codes explaining what is wrong with a claim. The phone numbers to contact either a person or an automatic information system are very clear. The website is cumbersome, but someone will walk you through it while they remain on the line with you. There are forms for everything if you cannot accomplish something by phone and while it is true the every “I” has to be dotted and “T” has to be crossed, the work I put in yields results. I cannot always say that about the other plans. Sometimes I wonder where the other plan’s rules come from – like a 90 day timely filing limit with NO room for appeal, explanation, or human error. Medicare’s timely filing deadline is one full year! And even after the year, there is another level of payment available with only 10% taken off the top; that seems fair to me in assigning mutual responsibility instead of simply throwing out the claim and forcing me to write an appeal usually in vain.

I know that a major argument against Medicare is the fee schedule, but if you examine your others plans closely, you will find there are non-Medicaid plans that pay the same or LESS than Medicare. And some of those plans make you jump through hoops to get certain procedures authorized, most of which do not require authorizations by Medicare. And there are also many codes that are bundled with non-Medicare plans but the proper use of modifiers can get you paid for each code with Medicare. Even when Medicare sends you a request for information, they have a standard system in place to process your response.

Finally, Medicare replacement plans have become popular of late mostly because it eliminates people from having to carry a secondary insurance. I am very opposed to them not only for the reasons that I like Medicare, but because these plans have wreaked havoc with beneficiaries. The replacement plans are not properly explained to retirees. So not only are doctors having more plans for which they have to obtain authorizations, I have been the bearer of bad news to patients when I have had to tell them that they must have signed some paper that transferred their health insurance to a replacement plan when that was not their intention.

The bottom line is that if you work within the process of Medicare you can spend more time caring for your patients and less time arguing with their insurance.

Fran Glucroft
Medical Office Manager
Fairfield, CT