Medicare hassle relief getting closer, but may not be enough

Physician groups are trying to strengthen provisions in the two bills moving through the House.

By Markian Hawryluk, AMNews staff. Oct. 22/29, 2001.

Washington -- The Snodgrass Medical Clinic in Larned, Kan., is a prime example of why physicians are clamoring for Medicare regulatory relief.

In May, the small rural clinic was audited by Medicare. The reviewers looked at 219 cases at Snodgrass Medical from 1998 and 1999, and denied 183 of them as inappropriate. They then calculated an error rate of 84% for the more than 4,100 Medicare claims filed during those two years and extrapolated an overpayment of $157,000. This for a clinic that is lucky to make $30,000 in a given year.

But this wasn't a case of fraud or questionable medical judgment. The clinic was cited for not having the first and last name of patients on every progress note in their charts and for allowing medical students to write progress notes in the presence of a physician, rather than having the physician write them himself.

The clinic uses the first name and date of birth for identification on the progress notes within a chart, which contains all the patient's information, said Marcia Snodgrass, a nurse practitioner and owner of the clinic. She bought the clinic from her physician husband, who had tired of Medicare regulatory hoops and decided he just wanted to practice medicine.

But what frustrates Snodgrass the most is that the Medicare contractor won't give her a straight answer.

"Every time I've called them to get questions answered, we get different answers," she said. "One will tell you this is billable, and then you call back and they say it's not. There's no set standard." [...]