Can Billing Get Even More Complicated?

In 2008, what other changes are in store for providers? In the last year, there were so many changes; here are just a few examples. Firstly, Medicare implemented a reimbursement decrease so complicated it would take five forensic accountants to understand the calculations. After all, isn’t that who came up with it in the first place? Next, they changed the universal billing form (formally known as the HCFA 1500 form) to the CMS 1500 form and with it new data elements. The old form was working for 25 years. Of course, they made these changes that required software vendors to jump through hoops in an effort to redesign the format to comply with these changes. Many providers’ software vendors were unable to meet the changes, and many doctors faced additional overhead costs to implement a new practice management option. Medicare then implemented the need for a national provider identification, or NPI, number and told providers it was “top secret,” and not to give it to anyone. Then CMS required NPI numbers for all referring physicians and outside places of service, which in itself was a feat, because how were you going to obtain the number if no one was giving it out because of the cloud of secrecy? Finally, Medicare lifted the gag order and told providers, “Never mind, it’s not secret anymore.” Flash forward to six months later. After providers had to call around 300 of their closest friends and associates to obtain their NPI numbers, physicians waited for a panel to sit around and decide that perhaps they should provide online inquiry for search capability to obtain these elusive NPI numbers. What do you think? Recently, a family member was visiting from out of state. He commented that everyone in California talks in a secret code. I asked him, “What was the secret code?” He said, “You take the 405 to the 101 to the 210 to the 57 to the 605.” For us in California, that’s everyday speak. It reminds me of the acronyms in billing we take for granted. How many numbers does one doctor need? In the course of the day, you have your license number, your EIN, DEA, CLIA, UPIN, PPIN, PIN, and now you have your NPI number, designed to simplify the need for all these numbers. Is anyone's life out there simplified? Now, most recently, the latest change required is the nine-digit ZIP code. Fabulous! So now countless hours are spent on the USPS website obtaining the four-digit extension on the ZIP codes, which will have multiple extenders on the same address because it depends on what suite is involved. Do you really think this is necessary? They say this will ensure that payment is made to the right location. Of course, don’t waste any more of your precious time questioning why. That will just result in a level of frustration 50 profound you may not recover. I think most people agree that if it is not broken, don't fix it. Clearly, healthcare providers have been successfully submitting claims to Medicare and Medical for many years. Why do these changes keep happening? Is it just me, or does it feel like a conspiracy to delay and withhold payment?