Stay Where You Are

If anyone out there is thinking of moving? Think again. Doctors do not realize how complicated it is to move their offices. If you are a member of a group and want to go out as an individual, or even something as seemingly simple as moving from one suite to another in the same building, it can cause your practice such a nightmare. It is better to stay where you are!

Imagine this scenario: if you are thinking of moving because you are cramped in your current office, get over it. It's better to be cramped with money than have "wide open spaces" with none. After all, you are a doctor, not a Dixie Chick. If you change suites within your existing address, it is considered "moving". You can smile at your mail carrier as much as you want to ensure you get your mail, but Medicare and Medical still consider this a new address. If you move from anywhere other than the address on file with Medicare, it is considered a new address, and therefore you will have to complete an entire new 45-page CMS application (CMS 855B(group) or 855 I (individual)). Medicare will also not forward checks. If any mail gets returned, all of your checks will be on hold until you update your profiles. This translates to no money. It's understandable how people feel they need to move from one state to another for a fresh start and to start over. But are you prepared to start your practice over from scratch for just moving down the hall?

Recently, a client I will call "Doctor Not Attentive To Details," employed by a large medical group, decided to go out on his own. From the insurance company's perspective, he no longer exists. To change your tax identification number, you have to re-credential with all the health plans. This can take sixty to ninety days depending on their backlog. If you are currently participating with a PPO such as Aetna or Cigna, you will have to apply to change your profile with them. This entails writing, faxing, emailing, even standing in the street and screaming at the top of your lungs, and that still might not help. During this delay, the health plans will notify patients that you are no longer an "active" provider, and therefore patients will cancel appointments because they do not want to get billed for going to an "out of network" provider. Again, this translates to no money. Claims will not be processed because the plans do not recognize the new tax identification number. If you try to schedule a surgery or an appointment, the health plan will not be able to authorize the care because you, as a provider, are not showing in their system.

We all share horror stories about care gone south. Here is one of credentialing gone awry. So, "Doctor Not Attentive To Details" employed a company to assist him in updating his profiles, and the company did it all wrong. They misspelled his corporation name, they notified the payers with an incorrect "pay to address," and they indicated he was an individual when he is, in fact, a new group. In addition, they added an extra digit to his UPIN number on the NPI registry. They submitted the Medicare application without including a participation agreement or an electronic data interchange agreement. Doctors, we know you are busy, but you have to be attentive to details, because all of these factors will affect your bottom line. I cannot stress enough the need to pay close attention to these details.

Surgeons are taught to count sponges for a reason. I found out while doing his surgical billing that there is an actual procedure code for the surgical removal of sponges. Luckily, I learned this from the billing side and not from the clinical side, withering in pain. By the way, this client hired me to fix it. We made a pact. I will be attentive to details, and he will count sponges.