Reimbursement Rocks

I traveled this weekend from Denver to Louisiana, to teach a compliance and documentation class. On the way there, on the second leg, in a very small and cramped airplane, I sat next to an Army Sergeant who was on his way home from Iraq. He hadn’t been home in a year or more. We visited a little bit about how excited he was to see his kids. He told me this was his fourth tour of duty to Iraq and he felt like he missed his 5 year old daughter’s childhood. All things in order, he should be coming home for good within 90 days of returning from R&R. He was a very nice, soft spoken gentleman, who enjoyed talking basketball with me. (One of my favorite things to talk about.) The subject naturally turned to the war and his involvement. Despite all that this man had been through and was enduring to serve his country, he admitted that we needed to be there, and that it was a good idea to finish what we started. Then, he said what really touched me. He said, “We appreciate all that the public does to try to get us home, but this is our profession, that we chose, and we knew what we were getting into”. In essence, he said, “this is my job, and I’ll do my job.”

Skip ahead to this Sunday’s class of chiropractors learning about documentation. We were in a part of the country where you have a lot of “old timey” DCs who have been in their small little town doing the same thing, the same way since who knows when. They were not so happy about this Denver girl coming in and explaining how Medicare works and that it’s NOT ok for them to just get around Medicare and make all those patients pay cash. Even after I laid out all the rules and regulations, there was defiance in some of their voices when they explained that they really didn’t have any intention of doing anything differently; regardless of what the government or the law says.

So I got to thinking about our government and the dictates of Medicare. Often, I’m asked about why the government would even CARE if a doctor has a patient pay cash because it’s just saving taxpayer money anyway, isn’t it? The short answer is that it’s because the government wants to protect the Medicare beneficiaries (patients) from unscrupulous doctors who will mislead them into believing that they HAVE to pay cash. Because of this, we’ve swung 180 degrees the other direction and are forced to bill EVERY CMT code to Medicare, maintenance or otherwise. The defiance in these doctors’ voices was clear: Don’t tell us what to do! We’ve done this for 40 years.

So, I’m mentally caught between the loyal and obedient soldier who “just does his job” and the doctor who defies Medicare rules and, yet, I can understand both sides. And still I find myself asking why these doctors don’t have a similar attitude as my soldier friend: “this is our profession and we knew what we were getting into”. I’m not a proponent of the status quo, and blindly following, never questioning. In fact, I think we should always speak our minds and fight for the right. But, Medicare has its rules and regulations. We should support and lobby ACA to change what doesn’t work, but compliance is necessary along the way; a necessary evil, but necessary nonetheless.
Who is right? Which way is best? I look forward to ideas and thoughts in both directions.