Thursday, October 1, 2009

A Simple Change of Address

By all means, let us reform health care in this country so that the federal government runs the whole enchilada, and not just Medicare. Here is a short story about my recent experience with Medicare that illustrates my point. In essence, this story is about reporting a change of address.

I am an ophthalmologist. I own a small solo practice in Orange County, NY. Recently, I decided to merge with another local practice, and I spent a year or so and about $15,000. in legal fees negotiating the contract (FYI, roughly 50% of those fees had to do with complying with state and federal regulations, and the other party's legal fees were even higher). We signed the contract in the first week of August, and the merger date was set for October 1. This gave us 2 months to get everything in order.

A big part of the preparations was informing Medicare of the merger, so that the new merged practice could be paid for my services. The idea is, Medicare has to know where each doctor sees patients, and where to send payments for services rendered. Currently, I see patients at one office, and payments are sent to the same address. The practice I am joining has 3 locations for examining patients, and one of those is the billing address.

Early in August we submitted, in triplicate, form CMS-855R, a 5 page document that notifies Medicare of a physician's change of status. 3 weeks later we received a 2 page rejection notice (also in triplicate), because a zip code had been left out of one of the addresses. So, I called Medicare, and had a lengthy conversation with a pleasant woman who walked me through the form step by step so that it would be completed correctly, and she assured me that that was all I had to do. Then, I resubmitted CMS-855R in triplicate. That's 36 pages so far, if you are keeping track.

Everything was going along just fine--just peachy--until Thursday, September 24, 2009. On that day, we received another 2 page rejection notice in triplicate, informing us that, although the triplicate CMS-855Rs were completed correctly, we were also required to submit CMS-855I, a 28 page enrollment form, and, by the way, resubmit new CMS-855Rs in triplicate. Page count: 85 total.

So, early Friday morning, I called Medicare again, and another very nice woman walked me through the CMS-855I. This took at least 30 minutes. She was very helpful. When she finished, she added, "do not forget the CMS-855B." "The what?" I said. She replied that the CMS-855B was to inform Medicare that I was merging with the other practice. The CMS-855B also must be submitted in triplicate.

The CMS-855B is 48 pages long and incomprehensible. So...
Friday afternoon, I called Medicare again, and spoke with another polite, but somewhat impatient government employee, and walked me through the 48 page form. I completed it as instructed, and, on Monday added these 144 pages to the stack and sent them by certified mail to Medicare, with a cover letter requesting expedited processing.
Total pages: 229
Total time: 4 or 5 hours of my time, 1.5 hours of Medicare employee time on the phone with me, 1 or 2 hours of staff time. Remember, all this is to change my address, and I do not yet know whether my forms have been accepted.

If I were a liberal, I would be outraged at the colossal waste of paper, the demise of trees, and at the carbon footprint of all this nonsense. But I am not a liberal, and I am outraged that our government wants to take over even more control of the health care system. This drama that I have been through proves to me that Medicare does not know how to process a change of address form, let alone run the nation's health care system.

Medicare was concocted by Congress, who also gave us the tax code. I believe that a change of billing and service addresses should require approximately 1 paper or web page, and should be easy to process by anyone with a middle school education, that is, by anyone who is SMARTER THAN CONGRESS.
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Anonymous said...

Doesn't the drama prove to you that you didn't know what you were doing? What were the legal fees for if they couldn't even tell you which forms to fill out?

Desman said...

The legal fees were about the agreement between me and the other practice. Are you suggesting that I should need a lawyer to inform Medicare of a change of address? You should be a lobbyist for the ABA, or the Trial Lawyers Association. Can you imagine if my lawyer had sat on the phone with Medicare doing the CMS-855I. That would be one happy lawyer. Here's an idea for you: go to the Medicare website, and surf a little.