GOVERNMENT & MEDICINE

Carrier backlogs continue to stall physician Medicare enrollment

CMS considers interest payments to doctors waiting to bill the program.

By Markian Hawryluk, AMNews staff. June 21, 2004.

Washington -- Although progress has been made in reducing the logjam, many physicians are still experiencing lengthy delays enrolling in Medicare or making simple changes to their enrollment data.

For physicians such as Robert Wierman, MD, an orthopedic surgeon from Gulfport, Miss., that means going months on end without any Medicare revenue and scrambling to find other funding to keep his practice open.

Three years ago, Dr. Wierman moved from New Jersey to join a clinic in Gulfport. Last year, when the clinic was sold, he decided to go out on his own. Despite having a Medicare billing number since 1973, Dr. Wierman had to submit an application with his new practice address.

That was in December 2003. After five months without payment from Medicare, which makes up about 40% of his revenue, he received his first check on April 30. "Something's not right there," he said. "All I did was change my address."

To add insult to injury, when checks came in, he discovered that Medicare now considered him a "nonparticipating" physician and paid him at a lower level. Although Dr. Wierman has been a participating physician in Medicare for 30 years, the carrier changed his status when the new application did not include a signed participation agreement.

Dr. Wierman since has changed his status but has not been able to make the change retroactive to Jan. 1. "It's bad enough I'm being paid 30 cents on the dollar on whatever I do, but then to rub your nose in it and not be helpful -- it's very frustrating."

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