Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

When Doctors Opt Out Of Medicare

I opted out of Medicare several years ago. This means I don’t see Medicare patients other than in the emergency room when I’m on unassigned call. I don’t submit bills to Medicare or to those patients. I just let it slide.

Last Wednesday I received the following letter from a large radiology group in my home town:

September 2010

RE:  PECOS Enrollment

To our referring physicians and their office managers:

At __________we have begun a project to identify ordering physicians who are not enrolled in Medicare’s Provider Enrollment, Chain and Ownership System (PECOS).  Our purpose is to remind physicians of the importance of enrollment to them and to us.

Beginning in January, 2011 those providers filing Medicare claims listing an NPI number on the claim of an unenrolled provider will have their claims denied.  This would apply to any claim you send in and to any claim we submit for services provided to your patients because we are required to list your NPI number on our claims.  This applies both to patients referred to our private offices and the hospitals where we provide radiology professional interpretations or services.

So, you can see our effort is not purely altruistic.  We have a financial interest in reminding you of the importance of PECOS enrollment.  In trying to ascertain whether you are enrolled, we are using an online program you can find at www.oandp.com/pecos.  Simply enter your NPI number in the entry block and press enter.  If you enter a valid NPI number, your name will appear and beside it will be a symbol indicating where Medicare recognizes your PECOS enrollment.

Since Medicare is continually updating the files, we may have accessed the system before your enrollment was completed.  We will continue to monitor the situation in hopes you will enroll if you intend to continue seeing Medicare patients.  If you have already enrolled or have no plans to enroll, please excuse our intrusion.

Sincerely,

This bothers me. It is not likely that I will be sending them any patients from my office, but that doesn’t mean there won’t be the occasional patient with my name on their chart in the ER. If I need to take a Medicare patient to the operating room from the ER, will the hospital not get paid? Will the anesthesiologist not get paid?

Will my non-participation in Medicare affect my fellow healthcare providers receiving payment? If so, that is just not right. I voiced this concern to Senator Blanche Lincoln shortly after receiving this letter. She agrees with me. Read more »

*This blog post was originally published at Suture for a Living*

Why Physicians Are Going To Stop Accepting Medicare

President Obama’s Healthcare Reform Bill will not work. It is based on decreases in physician reimbursement while forcing physicians to increase overhead with unaffordable electronic medical records. More and more physician groups and practices are starting to realize that they cannot make a living from the reimbursement from Medicare. They are quitting taking new Medicare patients and trying to get rid of the old ones by not taking assignment.

President Obama’s idea is to force physicians to be more efficient producers. It is very difficult to force anyone to do anything they cannot afford. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »