Physicians in Three States Owed Millions of Dollars From Medicare

Physicians in California, Hawaii and Nevada are owed millions of dollars in backlogged Medicare reimbursements, the Los Angeles Times reports. According to the Times, the problems stem from new universal identification numbers that CMS was supposed to assign to physicians by May. Without the number, physicians cannot be reimbursed. "Then, as scores of doctors still waited for those numbers, in September" CMS contracted with a new claims processor, Palmetto GBA, for California providers that compounded the billing problems and left even physicians who had universal ID numbers "waiting months for reimbursement," the Times reports.

Physicians who serve high numbers of Medicare patients said they are defaulting on rent, laying off staff and requesting that drug suppliers send drugs without payment. The California Medical Association said it has received calls from more than 1,000 physicians complaining of delayed reimbursements.

Rep. Henry Waxman (D-Calif.) said the transition to Palmetto was "marred by missteps." Waxman in a statement said, "I have been hearing from numerous doctors who have been waiting months for hundreds of thousands of dollars in reimbursements," adding, "The delay in payments threatens to compromise patient care and provider solvency." Physicians in Nevada also have complained about Palmetto.

According to the Times, Medicare beneficiaries "have been largely insulated from the reimbursement fight, though they may have difficulty making new appointments." However, some physicians, particularly specialists who receive low reimbursements, "say this could be the tipping point that makes them abandon their participation in Medicare altogether," the Times reports. Larry Mathies, executive director of the Nevada State Medical Association, said, "If we're still dealing with this in January or February, Medicare patients are going to have serious access problems."

Mike Barlow, a Palmetto vice president, said company officials are aware of the issues and have acted to address them by hiring more people to field calls and assembling teams to fast-track certain cases. Palmetto and Medicare said they are processing claims and expect the backlog will be eased by Dec. 31 (Yoshino, Los Angeles Times, 11/8).