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03/06/2018    Amy Schunemeyer, DPM

The Importance of Challenging Medicare

So, I noticed that my Medicare allowable was less
than the Novitas website posted allowables for my
claims coming back for 2018. There is a Novitas
mistake that the were following the WRONG fee
schedule up t0 2/23/18 and they are working on
resubmitting corrected claims. This is one
problem fixed.

And, I notice that the increased payment
adjustment is in the form of a positive ($xx.xx)
adjustment on our EMRs. This is a quite a
software accounting nightmare (How are others
handling this) and these are a few of my
questions because I am NOT receiving increased
payment from the many, many, many Medicare
Advantage plans. Do they have to pay me more
too?? Or are they somehow finding a way to squirm
out of it?

I finally found my QRUR for 2016; and was very
pleased and shocked that I performed as well as I
did; High quality and Average Cost. I am actually
GETTING MORE money from CMS!I was MORE shocked at
how many physicians are losing there rightful
income. I don't know if you care or have even
bothered to look at the stats, but I'm about to
give them to you.

1) I am 1 of only 20,000 clinicians receiving
positive payment. Why only 20,000? This is crazy!
There are 1,151,000 clinicians participating with
Medicare. This is only 1.8% of CMS docs. How am I
this extraordinary? (And I'm definitely NOT,
BTW). 65% reported something - so they DIDN'T get
a negative adjustment; and 26% got the automatic
% lost because they chose to blow CMS off.

2) I would LOVE to see how many of the 20,000
are DPM. I have a large wager that it’s a nice
chunk of the 20,000 docs.

3) If DPMs comprise a large number of those
receiving positive payment, then we as a
profession NEED to use this to our advantage!
That is toward the ever failing attempt to gain
physician status with Title XIX (19) Medicaid.

Also, I have been slowly but successfully
fighting with Medicare Advantage plans (WellCare;
BlueAdvantage; Peoples; Vantage to name a few)
regarding the ability of a DPM to dispense and
receive reimbursement for diabetic shoes and
wound care supplies.

I have NOT seen any other DPMs reporting these
issues (Or I just may be looking in the wrong
place). I find that my fellow DPMs find it too
difficult to fight these policies when they don’t
get paid. I see it as a slippery slope to losing
the privileges that we have.

If you have answers to any of these, please do
tell; otherwise I guess this is FYI and just my
opinion

Amy Schunemeyer, DPM, New Iberia, LA

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