Medicare Recertification for Doctors Another Obamacare 'Glitch'

Tuesday, 15 Oct 2013 01:20 PM

By Jennifer G. Hickey

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While computer problems marred the Affordable Care Act (ACA) roll out last week, "glitches" from the Obamacare law are more than an inconvenience for 1.25 million doctors working with Medicare patients.

Prior to Obamacare, physicians serving Medicare patients were required to complete a revalidation process, which entails resubmitting and recertifying the accuracy of their enrollment information, every five years.

With the new law in effect, the Centers for Medicare Services (CMS) announced plans to shorten the revalidation period, an initiative that caused even supporters of Obamacare like the American Medical Association to ardently voice their concerns about the impact of this decision on doctors.

Editor's Note: ObamaCare Secrets Revealed

One physician told Newsmax he feared that the complicated process will force some doctors to give up private practice or stop serving Medicare patients.

"I really enjoy being in private practice and being able to practice a particular style of medicine that I am concerned will be lost under these new regulations," says the dermatologist from Boca Raton, Fla., who asked not to be identified. A majority of his patients receive their healthcare through Medicare.

With doctors facing a March 2013 deadline to comply, AMA lobbied CMS to extend the deadline. Like many other provisions of Obamacare, the administration agreed to extend the initiative an additional two years to March 2015.

Physicians and medical groups have raised issues about parts of the certification and enrollment system since it was launched in December 2010 and government investigators have validated their concerns, finding numerous problems.

A May 2013 report issued by the Health and Human Services inspector general found inaccuracies in enrollment records contained in the National Plan and Provider Enumeration System (NPPES), which contains Medicare providers' information.

According to the IG report, an estimated 58 percent of enrollment records in the Provider Enrollment, Chain and Ownership System (PECOS) were inaccurate, and 48 percent of records in the NPPES had errors, including addresses, physician's names, and contact information.

"Inaccurate, incomplete, and inconsistent provider data coupled with insufficient oversight place the integrity of the Medicare program at risk and present vulnerabilities in all healthcare programs," the IG said.

In order to participate in Medicare, physicians must enroll through PECOS and if incorrect information is filed, they can have their privileges deactivated and must re-enroll, which can be a laborious and complicated process.

The concern about incorrect addresses is particularly unnerving to many doctors who are required under Obamacare to have their credentials revalidated within 60 days of the date they receive a notice from CMS. A failure to respond in time can result in deactivation of privileges.

While claims are filed online, CMS continues to send information verification requests by standard mail relying on the addresses – including the incorrect addresses – in the system.
According to Amednews, the journal of the American Medical Association, more than 23,000 health professionals and equipment suppliers have had their billing privileges deactivated during the initial stages of Obamacare implementation.

The revalidation requirements are yet another regulatory burden that has been placed on physicians and other Medicare providers as a result of Obamacare.

Even before the new law, doctors have for years called for reforms to alleviate the daunting challenge of complying with the myriad of regulations, rules, and paperwork required to maintain their Medicare privileges.

Editor's Note: ObamaCare Secrets Revealed

"We do not yet know what the impact will be, but personally whenever you have to revalidate it is a big hassle. It is just another administrative burden to handle," Dr. Daniel Spogen, chairman of the department of family and community medicine at the University of Nevada, tells Newsmax.

Spogen says about 60 percent of a physician's time is spent performing paperwork and only about 15 percent is face-to-face with patients.

"The more administrative reporting that is required, the more time you take away from patient care. For some physicians that will cause them to limit the number of [Medicare] patients they see," Spogen said.

One of the administrative burdens Spogen cites is the new coding system doctors must use when filing Medicare claims. Under the previous ICD-9 code system, for example, there were three separate codes for hypertension, but under the new ICD-10 system, there are 14 different possible codes.

Spogen says the biggest concerns from the physician's standpoint are the regulatory burden and that important healthcare decisions are going to be made by government officials and politicians.

"For a long time we have been concerned that a bunch of politicians who know nothing about healthcare could be dictating care."

Dr. Lori Heim, chairwoman of the American Academy of Family Physicians (AAFP) board, voiced concerns about the impact of Obamacare regulations on doctors in a letter to HHS Secretary Kathleen Sebelius.

The "regulations are often prone to unintended consequences, many of which place unfunded financial mandates on physicians and the medical practice businesses that employ them," she wrote.

"Many of these well-intended goals particularly disadvantage primary-care practices," Heim said.

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