Doctors decry payment delays after Medicare overhauls carrier system

Low-bidding contractors taking over from the old carriers are ill-equipped for the task, physicians say. By David Glendinning, AMNews staff. Oct. 13, 2008 in American Medical News Washington -- Medicare contracting reform was supposed to improve the physician claims process and make the program run more efficiently. But for many doctors, the process so far has had the opposite effect. The Centers for Medicare & Medicaid Services is partway through a nationwide initiative to replace the patchwork system of Medicare carriers and fiscal intermediaries with a Medicare administrative contractor system divided into 15 distinct jurisdictions. When the effort is complete by 2011, all physicians and hospitals in a given jurisdiction will have one MAC that has won a contract to handle all their Part A and Part B claims. For many physicians, this means going from a carrier they may have been billing for decades to a new, unfamiliar MAC with no prior dealings in the state. Some doctors who made the switch report that the new contractors are not up to the task. Leslie G. Bennett, MD, an internist in Queens, N.Y., suddenly stopped receiving Medicare checks in late June just as National Government Services was taking over from long-time local carrier Group Health Inc. NGS, the new MAC for New York and Connecticut, said it was working to resolve a backlog of claims, but Dr. Bennett's payments did not start flowing again until late September. By then, the months of missed Medicare checks had taken their toll. . . . . . . CMS continues to work individually with doctors on payment problems. Jackson said a physician first should try to resolve issues with his or her new MAC and then call the CMS regional office if the attempt is unsuccessful. In some cases, MACs might be able to approve advance Medicare payments if the physician demonstrates a major cash-flow problem.