Hi. I know, it's been quite a while. How's everyone been?
This post is from the "We're from the government and we're here to help you" edition of my last two months, and addresses a situation that caused a bit of a scramble in my practice to keep things moving along until the behemoth federal bureaucracy got its act together. By way of explanation ...
As I've told you previously, my orthopaedic practice, which was formerly located in northeastern Massachusetts, made a decision a while ago that our fortunes, due to the climate for medical practice in the Bay State among other things, might be enhanced by a five mile move north, across the border into southern New Hampshire. So we located a site for a new building, which just happened to be proposed by a symbiotic business, planned the new offices and businesses, and built. We moved into the new digs in early March. And I've been putting out brushfires ever since, from unfinished building work to roof leaks to xray equipment delays to ... well, you name it.
There have been a boatload of issues to deal with, although they've all been relatively minor and manageable, and they've been largely handled. Except one, and this is where our government bureaucracy has been less than helpful. You see, in moving across the border we had to change from a Massachusetts corporation to a New Hampshire PLLC, since we weren't maintaining an office address in Mass. This required establishing new company registration in New Hampshire, and new accounts. And also, more importantly, a new set of Medicare provider numbers for both the business and for the six individuals providing patient care and billing Medicare.
Ah, I hear you ask, since you were all providing care for patients and billing CMS prior to moving, couldn't you simply transition those provider numbers to the new company? No, CMS insists on giving you a new number. No, I don't know why. I'm the same guy I was in Massachusetts, treating many of the same patients. If I left the practice and joined a group in, say, Oregon I'd have the same provider number, as I understand it. But moving the group and changing the name required new numbers.
And now it gets tricky. You see, you can't even file an application for the new number with CMS until you are seeing Medicare patients in your new location under your new address. Then, of course, the bureaucracy kicks in and what should take a week takes six. During this time you're continuing to see Medicare patients, and accumulate unbilled charges, while you wait for your numbers. And wait. And wait.
So the Medicare provider numbers arrived. Finally. In mid-April. Hooray!!! Ah, but there's a catch. You see, as a "new" provider we are required to register with CMS for direct deposit of payments into our account via wire transfer, and until that's done we still can't send out the electronic bills, and the unpaid charges continue to accumulate. And that registration can't occur until you have the provider numbers. "How long could it possibly take to set this up?" I hear you ask. A day or two? No, more like two to three more weeks. Yeah, I know.
So we've been seeing Medicare patients and accumulating unbilled and unpaid charges for two full months now, and I'm really hoping this week is the week. Because it hasn't been two months, it's been three. You see, when we moved out of our old location it was immediately rented to another medical practice, an internist. We didn't have the wire transfer deposits set up for our old practice (hey, we were moving and changing accounts), and government checks can't be forwarded, they must be returned to sender and re-issued. So at the beginning of March when a bunch of Medicare payments were sent to our old address they were returned to the government and couldn't be re-issued until those new numbers were issued.
It's perhaps not surprising that people over the age of 65 need a lot of orthopaedic care. Many of them have reached the expiration dates on their hips, knees, and shoulders and need the services of a competent orthopaedist. How much could three months of Medicare payments be? We've been plodding along short about 7-8% of our total annual practice income.
On the bright side, the transition for the private insurers was seamless, with payments coming in right from the get-go at the new location, even without new Medicare numbers. Also on the bright side, Medicare does allow us to bill all of the accumulated charges once we get the numbers and wire transfers in order, so that income should eventually catch us up. We'll survive this, and prospects for the future in the new location are looking great for a lot of other reasons.
But, and I say this having now lived through the shark attack and survived, the federal government could not have made it more difficult. Seriously.
