GOVERNMENT

Medicare enrollment delays leave doctors out in the cold

A new database has slowed contractors' ability to process applications.

By Markian Hawryluk, AMNews staff. Feb. 23, 2004.

Washington -- Keith Davis, MD, is the only physician in the 1,200 square miles of Lincoln County, Idaho. His primary care practice in Shoshone is not even rural -- it's frontier.

So the family physician was thrilled in October to hire a locally born and raised physician assistant, Johnny Urrutia, to help care for his 5,000 patients. But four months later, Urrutia is still waiting to be approved by Medicare.

Although Urrutia has a billing number from his previous job, Idaho's Medicare contractor has yet to issue a number he can use from the Shoshone office.

"It just seems kind of strange that it should take so long to get a number for somebody who's in the system already," Dr. Davis said. "It really creates a cash flow issue when you have Medicare patients coming in. He can see them, but we can't bill for it."

Dr. Davis and Urrutia are not alone in their quandary. Nationwide, physicians and others participating in Medicare Part B have run into lengthy delays in getting new enrollment applications or even simple address changes processed since the Centers for Medicare & Medicaid Services implemented a new enrollment database in November 2003.

"It's not an isolated issue," said Justine Handelman, executive Washington director for the BlueCross BlueShield Assn. "If you talk with any of our carriers, they've been experiencing the same problem."

Each Part B carrier had previously operated its own enrollment program with unique decision-making rules. There was no centralized depository of information on physicians enrolled in Medicare and no way of sharing information between carriers.

[...]

Full text of AMNews content is available to AMA members and paid subscribers.

Access details

Join the AMA