Home Forums Discussions General Discussion Won A Round

I am sure many of you have also been sent faxes or letters from a variety of Managed Medicare companies stating that for them to keep their contract with Medicare they have to document accurate diagnosis and coding practices performed by you the physician. They then request that your office mail to them records on numerous patients so they can review them and then report their findings.

Well, I have been going around and around recently with one of these companies (begins with H). Their first letter did not include a return fax number so I simply deleted it. After they called me on the phone I told them I would respond to their fax only when they provided me with a return fax number. Their next request for records letter had a return fax number on it so I faxed theirs back with the following comment, "You are welcome to come to my office and review any of the above charts but I will not use my staff nor my resources to gather and transmit this information to you."

A few weeks passed and then I got a phone call asking if I got their fax and I replied, "yes", did they get my fax, and they said "yes" and I said "why are you wasting my time asking me if I got your fax when you know very well I did because I returned it to you?" The person on the other line stammered and then recovered and then asked if I was going to send them the info. I told them to go read the fax and hung up.

Today, someone else calls and tells me they cannot send someone to my office but, if they pay me for the gathering and copying of this information would I then do it. I told them of course, as long as they reimburse me for the amount of staff time at the hourly rate that I pay the person who would do this. They agreed and told me to send them the bill, they would pay and then we will send the records.


Leslie, grinning from ear to ear.

I hope you documented the name of the insurance staff member, and I wish you luck in actually collecting, but your approach is correct in insisting upon payment first as delay will not affect patient care.

Good going, Leslie. I will not see any patient with an insurance beginning with the letter 'H'. "Such a company" is the worst. Not only have I had problems as a physician, but years ago when my family had such insurance they d8888'd us around. (I still vow never to pay that bill if they come after me twenty years from now).

One of those companies had an outside company contact me and request them - sent more on 2-3 occasions and it said that they were not obligated to pay for them and it was required. I spoke with compnay directly and they informed me that it was not required and they would not penalize me for not doing it. I found that when I told them no - they gave up, had been having me do it more than once per year because I said yes.....

I just send an invoice for medical records to them like I would to a lawyer or any other 3rd party. Here in MO we are allowed by the state to charge $0.47 per page + $20.02 handling + postage + notary fee if required. (State mandated fees are for things related to state government related requests for records, but I charge the same to everyone - makes it easier for staff). They always pay before I send the records. A month or 2 ago had a chart that cost the insurance Co about $75 to get and they paid no problem.

You go girl!

We aren't medicare providers so that information is all new to me. However, we do also charge for any medical records that we have to copy/print and send out. The state of Oregon allows a significant amount for it (to pad their own pockets) $30.00 for the first 10 pages, $0.50 a page from 11 - 50, $0.25 a page for 51 pages plus, postage, and an expedite fee of $7.00. We invoice everyone before we do anything with a chart, with the exception of patients who go on Medicare. Those charts we'll copy and forward as a courtesy. Many patients really grumble about it. We've found they determine what they think is really important to be sent on.

I had a similar experience with a company who was contracted by a carrier recently. They requested that at my convenience could I please copy all the information for the last 3 years on 65 charts and send it to them. I said I didn't think like that seemed like something I wanted to do and pointed to the clause in my contract which stated I agreed to grant them access to the charts at THEIR cost. I also reminded them that the same contract states that I have a right to the results of their audit and that I would be entitled to payment for charges I had overlooked. I haven't heard anything for a while.

The only way to win the game is not to play..... I called rep from insurance company and they told me I did not have to supply them and it was up to me...no repurcussions and they didn't care.

I agree with Steve. We need to not play their games. I also won't play the game where I give a patient a perfectly good, legible, legal script, they mail it in to their mail-order pharmacy and the pharmacy then faxes me a request to confirm the prescriptions. I refuse.

Leslie,

What happens when you refuse to confirm the Rx?

I get a call from the pt that I refused to fill the request and the pt doesn't get the Rx and is now mad.

Let them be mad. But at the pharmacy.

I tell them it is their insurance/pharmacy's doing. I have done my part by providing them with a script which is legal in the state in which I am licensed. They should call their insurance and complain or use a local pharmacy.

Just got a stack of requests like this. The cover sheet had no company info, no return fax number, and no offer to pay was included in the note.

I am so thankful that you gave us this wonderful strategy.
Thanks Leslie

Vicki,

You are welcome. We physicians need to stand strong against these intruders in our busy day. Just because it looks like an official "We are here to scare you" document doesn't mean squat. I especially love the ones that say something like "Your failure to return the request for refills within one business day may result in your patient not receiving their medicines." I reply to those, "My patients are told up front to allow me 72 hours to refill their scripts. Should they not do so, I will advise them to get their scripts filled at a local pharmacy." It almost never takes me 72 hours to refill but I'll be damned if an insurance company will tell me how to run my practice.

I like your style Leslie!