Re: Medicare Inequities

[Guest guest]

Medicare reimburses on the basis of RVU’s which are composed of “work elementâ€, “malpractice elementâ€, and “cost of business element.†The malpractice and cost of business elements vary across the country while the work element does not. The work element is that part which committee’s assign a value based on what they believe it’s worth considering difficulty and anything else they perceive as value.

As to the “administrators†of medicare, these are private sector administrators which process claims and disburse checks. The also manage the everyday nuances of claims such as turning down claims or dealing with the appeals. In Pennsylvania, the administrator of medicare is Highmark which is a BC/BS entity, but the medicare administration arm just got sold to some other entity in Florida. Supposedly, nothing will change even though the ownership is apparently out of state. The administration headquarters remain in state at Camp Hill.

WK

From: roxywible

Sent: Thursday, December 29, 2011 5:51 AM

To:

Subject: Medicare Inequities

Can anyone explain why reimbursement varies so much regionally with Medicare?Also why do physicians in Oregon have to go throughan administrator in North Dakota (Noridian LLC) to getclaims processed for Medicare?My mother (a bored retired psychiatrist) is interestedin researching the Medicare money trail and would likesome leads.She writes: Part of Medicare has been privatized and in returned insurance companies funded re-election of congress. I am unclear who actually manage Medicare reimbursements, however I suspect insurance companies do. I would have to look closely at the reimbursement check for a better understanding. Again I think government funds are funneled thru corporations one way or another.Appreciate any help. . .PamelaPamela Wible, MD3575 St. #220 Eugene, OR 97405www.idealmedicalcare.org"(S)He is the best physician who is the most ingenious inspirer of hope."~ Coleridge=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.18940)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.18940)http://www.pctools.com=======

[Guest guest]

The administrators are on contracts as well. Similar to any government contracted entity, they put bids in to CMS and are awarded based on whom CMS will deliver the best results at the lowest price. Our carrier change from NHIC to Palmetto a few years back. This caused disruption for many MD's in payment - they did not get paid in a timely manner. We did not have this trouble because I was on the ball and filed paperwork as soon as we were able. I believe the ones with the most trouble waited until the deadline to file their paperwork and due to the high volume, they were processed slowly. Palmetto is in GA. We are in CA.

Medicare reimburses on the basis of RVU’s which are composed of “work elementâ€, “malpractice elementâ€, and “cost of business element.†The malpractice and cost of business elements vary across the country while the work element does not. The work element is that part which committee’s assign a value based on what they believe it’s worth considering difficulty and anything else they perceive as value.

As to the “administrators†of medicare, these are private sector administrators which process claims and disburse checks. The also manage the everyday nuances of claims such as turning down claims or dealing with the appeals. In Pennsylvania, the administrator of medicare is Highmark which is a BC/BS entity, but the medicare administration arm just got sold to some other entity in Florida. Supposedly, nothing will change even though the ownership is apparently out of state. The administration headquarters remain in state at Camp Hill.

WK

From: roxywible

Sent: Thursday, December 29, 2011 5:51 AM

To:

Subject: Medicare Inequities

Can anyone explain why reimbursement varies so much regionally with Medicare?Also why do physicians in Oregon have to go throughan administrator in North Dakota (Noridian LLC) to getclaims processed for Medicare?My mother (a bored retired psychiatrist) is interestedin researching the Medicare money trail and would likesome leads.She writes: Part of Medicare has been privatized and in returned insurance companies funded re-election of congress. I am unclear who actually manage Medicare reimbursements, however I suspect insurance companies do. I would have to look closely at the reimbursement check for a better understanding. Again I think government funds are funneled thru corporations one way or another.Appreciate any help. . .PamelaPamela Wible, MD3575 St. #220 Eugene, OR 97405www.idealmedicalcare.org"(S)He is the best physician who is the most ingenious inspirer of hope."~ Coleridge=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.18940)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.18940)http://www.pctools.com=======